稀な原因による脊髄空洞症の3例

Abstract

In many cases, syringomyelia is associated with Chiari malformation and spinal cord tumor. We report three cases of syringomyelia due to unusual causes. [Case 1] 64 years old, a woman. She had painful numbness and weakness of the right hand. MRI showed broad syringomyelia, which extended from C2 to Th2 and severe spinal cord compression at C6/7 level derived from spondylotic spur formation. Dynamic cervical X-ray revealed mild anterior sliding at C4/5. We performed anterior decompression and fusion with titanium cylindrical cages for two segments (C4/5 and C6/7). Since syrinx had regressed three months later on MRI, we suspected that dynamic cervical movement had gradually caused syringomyelia. [Case 2] 61 years old, a man. He had suffered bilateral leg numbness and gait difficulty for several years. On MRI examination, intramedullary cystic mass and syrigomyelia were detected at thoracic spine. In operation, thickened and turbid arachnoid membrane was widely dissected and free cerebrospinal fluid collection pathway was preserved after duroplasty with fascia. Syrinx regressed on MRI after three months, so we diagnosed syrigomyelia due to idiopathic adhesive arachnoiditis. [Case 3] 73 years old, a man. Over 40 years before, he was surgically treated for thoracic vertebral caries. He had gradually developed gait disturbance and paraparesis for several years. MRI revealed intramedullary cyst (syrinx formation) at ThlO. Concurrently meningeal thickening was found. We judged that syringomyelia occurred as a late complication of tuberculous meningitis. Unfortunately our surgical procedure, syringostomy and dissection of arachnoid membrane, did not improve his deficits.