Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature
Posttubercular adhesive arachnoiditis is a rare, late complication of tubercular meningitis. Syringomyelia can develop as a consequence of intramedullary cystic lesions and cerebrospinal fluid (CSF) flow disturbance around the spinal cord, even after successful chemotherapy. We reviewed the literatu...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2017-04-01
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| Series: | Journal of Neurological Surgery Reports |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1601327 |
| _version_ | 1828467015256375296 |
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| author | Giuseppe Canova Alessandro Boaro Enrico Giordan Pierluigi Longatti |
| author_facet | Giuseppe Canova Alessandro Boaro Enrico Giordan Pierluigi Longatti |
| author_sort | Giuseppe Canova |
| collection | DOAJ |
| description | Posttubercular adhesive arachnoiditis is a rare, late complication of tubercular meningitis. Syringomyelia can develop as a consequence of intramedullary cystic lesions and cerebrospinal fluid (CSF) flow disturbance around the spinal cord, even after successful chemotherapy. We reviewed the literature related to posttubercular syringomyelia treatment and suggest a new combined surgical approach. A 25-year-old Nigerian male patient presented with legs numbness, urinary disturbance, and legs weakness. Spinal magnetic resonance revealed a T5-T7 syringomyelia, secondary to adhesive spinal arachnoiditis related to a history of tuberculous meningitis. Adhesiolysis by direct visualization with a flexible endoscope was performed and a handmade S-italic syringe-subdural shunt was placed to restore CSF flow. During the postoperative course, the neurological deficits improved together with the resolution of the syrinx. Long-term magnetic resonance imaging follow-up documented no recurrences or shunt displacements. We suggest that, when antitubercular therapy is not effective to resolve postarachnoiditis syrinx, arachnolysis with a flexible endoscope together with the placement of an S-italic shunt allowed free CSF communication between the syrinx and the subarachnoid space. Furthermore, we support that the use of an s-shaped shunt could prevent displacement or migration of the device and allows an easier revision in case of acute or late complications. |
| first_indexed | 2024-12-11T03:59:04Z |
| format | Article |
| id | doaj.art-8a2437e1b8a545b292cee0da5666b007 |
| institution | Directory Open Access Journal |
| issn | 2193-6358 2193-6366 |
| language | English |
| last_indexed | 2024-12-11T03:59:04Z |
| publishDate | 2017-04-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Journal of Neurological Surgery Reports |
| spelling | doaj.art-8a2437e1b8a545b292cee0da5666b0072022-12-22T01:21:41ZengGeorg Thieme Verlag KGJournal of Neurological Surgery Reports2193-63582193-63662017-04-017802e59e6710.1055/s-0037-1601327Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of LiteratureGiuseppe Canova0Alessandro Boaro1Enrico Giordan2Pierluigi Longatti3Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, ItalyDepartment of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, ItalyDepartment of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, ItalyDepartment of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, ItalyPosttubercular adhesive arachnoiditis is a rare, late complication of tubercular meningitis. Syringomyelia can develop as a consequence of intramedullary cystic lesions and cerebrospinal fluid (CSF) flow disturbance around the spinal cord, even after successful chemotherapy. We reviewed the literature related to posttubercular syringomyelia treatment and suggest a new combined surgical approach. A 25-year-old Nigerian male patient presented with legs numbness, urinary disturbance, and legs weakness. Spinal magnetic resonance revealed a T5-T7 syringomyelia, secondary to adhesive spinal arachnoiditis related to a history of tuberculous meningitis. Adhesiolysis by direct visualization with a flexible endoscope was performed and a handmade S-italic syringe-subdural shunt was placed to restore CSF flow. During the postoperative course, the neurological deficits improved together with the resolution of the syrinx. Long-term magnetic resonance imaging follow-up documented no recurrences or shunt displacements. We suggest that, when antitubercular therapy is not effective to resolve postarachnoiditis syrinx, arachnolysis with a flexible endoscope together with the placement of an S-italic shunt allowed free CSF communication between the syrinx and the subarachnoid space. Furthermore, we support that the use of an s-shaped shunt could prevent displacement or migration of the device and allows an easier revision in case of acute or late complications.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1601327posttubercular complicationsyringomyeliaarachnoiditisspinal shuntflexible endoscopy |
| spellingShingle | Giuseppe Canova Alessandro Boaro Enrico Giordan Pierluigi Longatti Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature Journal of Neurological Surgery Reports posttubercular complication syringomyelia arachnoiditis spinal shunt flexible endoscopy |
| title | Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature |
| title_full | Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature |
| title_fullStr | Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature |
| title_full_unstemmed | Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature |
| title_short | Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature |
| title_sort | treatment of posttubercular syringomyelia not responsive to antitubercular therapy case report and review of literature |
| topic | posttubercular complication syringomyelia arachnoiditis spinal shunt flexible endoscopy |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1601327 |
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