- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
- Associate Professor of Surgery, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut, USA
Correspondence Address:
Charles F. Opalak
Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
DOI:10.4103/2152-7806.170437
Copyright: © 2015 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Opalak CF, Opalak ME. Arachnoiditis ossificans and syringomyelia: A unique presentation. Surg Neurol Int 25-Nov-2015;6:
How to cite this URL: Opalak CF, Opalak ME. Arachnoiditis ossificans and syringomyelia: A unique presentation. Surg Neurol Int 25-Nov-2015;6:. Available from: http://surgicalneurologyint.com/surgicalint_articles/arachnoiditis-ossificans-and-syringomyelia-a-unique/
Abstract
Background:Arachnoiditis ossificans (AO) is a rare disorder that was differentiated from leptomeningeal calcification by Kaufman and Dunsmore in 1971. It generally presents with progressive lower extremity myelopathy. Though the underlying etiology has yet to be fully described, it has been associated with various predisposing factors including vascular malformations, previous intradural surgery, myelograms, and adhesive arachnoiditis. Associated conditions include syringomyelia and arachnoid cyst. The preferred diagnostic method is noncontrast computed tomography (CT). Surgical intervention is still controversial and can include decompression and duroplasty or durotomy.
Case Description:The authors report the case of a 62-year-old male with a history of paraplegia who presented with a urinary tract infection and dysautonomia. His past surgical history was notable for a C4–C6 anterior fusion and an intrathecal phenol injection for spasticity. A magnetic resonance image (MR) also demonstrated a T6-conus syringx. At surgery, there was significant ossification of the arachnoid/dura, which was removed. After a drain was placed in the syrinx, there was a significant neurologic improvement.
Conclusion:This case demonstrates a unique presentation of AO and highlights the need for CT imaging when a noncommunicating syringx is identified. In addition, surgical decompression can achieve good results when AO is associated with concurrent compressive lesions.
Keywords: Arachnoiditis ossificans, intrathecal phenol, syringomyelia
INTRODUCTION
Arachnoiditis ossificans (AO) is a rare pathological entity that was differentiated from benign leptomeningeal calcification by Kaufman and Dunsmore in 1971.[
In this report, we describe a patient presenting with dysautonomia and a noncommunicating syringomyelia attributed to an intrathecal phenol injection.
CASE REPORT
TC, a 62-year-old male, quadriplegic secondary to a diving accident 34 years previously (at which time he was treated with a C4–C6 anterior cervical decompression and fusion), presented with dysautonomia. He had received an intrathecal phenol injection for spasticity several years later.
When MR demonstrated a large syrinx extending from T6 through the conus, he was scheduled to undergo drainage of the syrinx [Figure
A laminectomy of T12 through L1 was performed and the intact dura was incised in the midline. Significant calcification was discovered [
Postoperatively, TC's dysautonomia regressed. Notably, a thoracic CT scan [Figure
DISCUSSION
There are several theories regarding pathogenesis of AO such as chronic adhesive arachnoiditis, irregular calcium metabolism, genetic factors, the next stage in the lifecycle of arachnoidal granulations, and now, intrathecal phenol injection has been associated with AO.[
The concurrence of syringomyelia with AO is considered either purely incidental, the result of vascular ischemia resulting in cavitation or due to a disturbance of CSF flow.
Although there is continued controversy surrounding the surgical treatment of AO, in this case, as in several others good results were achieved with decompression and shunt placement.[
CONCLUSION
Cases of AO are exceedingly rare and the full extent of these lesions should be documented utilizing CT.[
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
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