Theco-thecal bypass technique elucidating a novel procedure and perspective on treatment of post-arachnoiditis syringomyelia:A case report

摘要

BACKGROUND Post-arachnoiditis syringomyelia is a condition in which there is an intraspinal cerebrospinal fluid(CSF)blockade due to arachnoidal adhesions and bands.Although many of the techniques currently in use,namely,the theco-peritoneal,syringo-pleural,syringo-peritoneal,and syringo-subarachnoid shunts,are effective,the results are often variable.CASE SUMMARY A 36-year-old man with a past history of pulmonary tuberculosis,presented with progressive paraesthesia in the feet and progressive paraparesis along with constipation,difficulty in micturition,and decreased libido.He was bedridden a month before presentation.Magnetic resonance imaging revealed a dorsal multiloculated syrinx from D3-D10 vertebral levels.He underwent a D1-2 to D11 theco-thecal shunt bilaterally to abolish the CSF gradient across the level of the syrinx.There was no direct surgical handling of the spinal cord involved.At the 15-mo follow up,the patient had significant improvement in his symptoms and function.CONCLUSION We present a novel technique aimed at correcting the primary cause of a postarachnoiditis syrinx,the subarachnoid cerebrospinal flow obstruction or block,which we believe is simple and effective,involves minimal handling of the normal neural structures,and attempts to restore the physiology of CSF flow across the obstruction,with favorable clinical results.