Korean J Neurotrauma.  2017 Apr;13(1):34-38. 10.13004/kjnt.2017.13.1.34.

Surgical Management of Syringomyelia Associated with Spinal Adhesive Arachnoiditis, a Late Complication of Tuberculous Meningitis: A Case Report

• Lee JS
• Song GS
• Son DW

• KMID: 2378248
• DOI: http://doi.org/10.13004/kjnt.2017.13.1.34

Abstract

Syringomyelia associated with tuberculous meningitis is an extremely rare condition. Only a few studies have reported clinical experience with syringomyelia as a late complication of tuberculous meningitis. Twenty-six years after a tuberculous meningitis episode, a 44-year-old man presented with progressively worsening spastic paresis of the lower limbs and impaired urinary function for 2 years. Radiological examination revealed syringomyelia extending from the level of C2 to T9 and arachnoiditis with atrophy of the spinal cord between C2 and T3. We performed laminectomy from C7 to T1, dissected the arachnoid adhesion and placed a syringo-pleural shunt via keyhole myelotomy. One year after the operation, his neurological condition improved. The postoperative control magnetic resonance imaging revealed the correctly located shunt and significantly diminished syringomyelia cavities. We aim to discuss the mechanism of syrinx formation following tuberculous meningitis and to share our surgical therapeutic experience with this rare disease entity.

Keyword

Cerebrospinal fluid shunts; Syringomyelia; Tuberculosis, meningeal

MeSH Terms

Adhesives*
Adult
Arachnoid*
Arachnoiditis*
Atrophy
Cerebrospinal Fluid Shunts
Humans
Laminectomy
Lower Extremity
Magnetic Resonance Imaging
Muscle Spasticity
Paresis
Rare Diseases
Spinal Cord
Syringomyelia*
Tuberculosis, Meningeal*
Adhesives

Figure

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  FIGURE 1 Initial magnetic resonance imaging demonstrated syringomyelia from C2 to T3 which was thought to be secondary to adhesive spinal arachnoiditis. (A) Sagittal T2 image. (B) Sagittal T1 image with contrast enhancement. (C) Axial T1 image with contrast enhancement.

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  FIGURE 2 Small calcification, which may be related with tuberculosis scarring in left frontal horn of lateral ventricle was detected on brain magnetic resonance imaging.

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  FIGURE 3 Spinal angiography was performed to rule out vascular anomaly.

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  FIGURE 4 On microscopic operative view. (A) Photograph shows thickened arachnoid and dura mater. (B) Catheter tip was placed in the syrinx cavity and secured with dura.

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  FIGURE 5 One year after operation, magnetic resonance imaging demonstrated catheter positioned properly in syrinx and diminished syringomyelia. (A) Sagittal T2 image. (B) Axial T2 image.

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