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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 Canova
1   Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
,
Alessandro Boaro
1   Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
,
Enrico Giordan
1   Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
,
Pierluigi Longatti
1   Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
› Author Affiliations
Further Information

Publication History

07 October 2016

18 January 2017

Publication Date:
17 April 2017 (online)

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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.

Keywords

posttubercular complication - syringomyelia - arachnoiditis - spinal shunt - flexible endoscopy

Informed Consent

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


 

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