CC-BY-NC-ND 4.0 · J Neurol Surg Rep 2017; 78(02): e59-e67
DOI: 10.1055/s-0037-1601327
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature

Giuseppe Canova1, Alessandro Boaro1, Enrico Giordan1, Pierluigi Longatti1
  • 1Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
Further Information

Publication History

07 October 2016

18 January 2017

Publication Date:
17 April 2017 (online)

Abstract

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.

Informed Consent

An informed consent was obtained from all individual participants included in the study.