Surgical Management of Secondary Syringomyelia associated with Spinal Surgery

A case of delayed onset of secondary syringomyelia associated with spinal surgery is presented and the mechanism of syrinx formation and surgical treatment are discussed. This 59 year old woman had an intradural thoracic Schwannoma and developed a thoracic syrinx 25 years after surgery on the thoracic Schwannoma. She complained of paresthesiae below the lower thoracic level. There was mild weakness in both legs. Hypalgesia was presented below T9. MRI showed a syrinx with adhesive arachnoiditis in the thoracic levels at the operated site. We performed a syrinx-subarachnoid shunt after microsugical lysis between the dura and the adhesive arachnoid membrane. An expanded polytetrafluoroethylene sheet (Gore-Tex® sheet) was inserted to maintain CSF flow. Postoperative neurological deterioration did not occur for 1 year postoperatively, but postoperative MRI showed a recurrence of the syrinx. These results suggest that postoperative adhesive spinal cord arachnoiditis can cause syrinx formation, and this procedure may be inappropriate surgical treatment for patient with longitudinally extensive arachnoiditis.