sm surgery with gortex !

[Guest guest]

wow ...i pasted only the introduction and pubmed citatations here ...but the

full article including pictures ect is available free linked to the pubmed

citation. this is facinating and good news folks , far as i can tell a long

awaited /anticipated use of gortex above the lumbar area ect .

INTRODUCTION

In the treatment of syringomyelia associated with spinal adhesive

arachnoiditis, several authors have proposed the technique of lysis

of adhesion to resolve the major pathogenic factors responsible for

syrinx initiation and propagation: cord tethering and blockage of

the subarachnoid space caused by adhesion.1–6 Surgical outcome

by arachnoid dissection, however, is limited by the risk of surgical

damage to the cord and postoperative recurrence of adhesions.7–10

We report a new surgical technique developed to prevent the

recurrence of adhesions and in order to maintain continuity of

the reconstructed spinal subarachnoid space following arachnoid

dissection.

CASE REPORT

A 47 year old male was admitted with the complaint of numbness

of the left hand which had developed 6 years previously with a

slow progressive course and extended to all extremities during the

following 5.5 years. Urinary disturbance developed over the last 6

months. In the following 4 months micturition was possible only

by suprapubic compression with a resultant residual volume. The

patient was catheterised in another institute because of urinary

retention 2 months before admission. There was no past history of

spinal injury, previous spinal operation or myelography, but there

was a history of pulmonary tuberculosis complicated by meningi-tis

28 years earlier. On admission, the patient was fully conscious.

Mild weakness of the fingers of both hands with muscle atrophy

was found. Deep tendon reflexes in both extremities were exag-gerated.

Hypalgesia was found below the level of T4 on both

sides without any sacral sparing. Sphincter tone was depressed.

Urodynamic study revealed a spastic bladder. Magnetic resonance

imaging (MRI) showed syringomyelia from C2 to T2 without an

enhanced lesion. The subarachnoid space on the dorsal side of the

cord between C3 and C7 was absent, suggesting arachnoiditis at

the same level (Fig. 1).

Operation

The patient was positioned in the semiprone park bench position

lying on the right side. A midline skin incision with muscle sepa-ration

was made to expose C1 down to T4. Laminotomies from

C2 down to T3 were performed, then a midline dural incision was

made from C3 down to T3 without opening the arachnoid mem-brane.

As the arachnoid membrane incision was made in the mid-line,

its edges were taken with the dural edges using a 6-0 suture

and anchored laterally to the paraspinal tissues together with the

dura (Figs 2 and 3). Opening of the arachnoid membrane, lysis of

adhesions and lateral anchoring of the dura and arachnoid were

performed in a stepwise manner. Adhesive arachnoiditis was found

dorsal to the dentate ligament extending from C4 down to T3.

Journal of Clinical Neuroscience(2001) 8(1), 40–42

© 2001 Harcourt Publishers Ltd

DOI: 10.1054/jocn.2000.0731, available online at http://www.idealibrary.com on

Technical note

Surgical management of syringomyelia associated with

spinal adhesive arachnoiditis

Kenji Ohata 1 MD, Takeo Gotoh 1 MD, Yasuhiro Matsusaka 1 MD, Michiharu Morino

1 MD, Naohiro Tsuyuguchi 1 MD,

Bassem Sheikh 1 MD, Yuichi Inoue 2 MD, Akira Hakuba 1 MD

Departments of 1 Neurosurgery and 2 Radiology, Osaka City University Medical

School, 1-5-7 Asahi-machi, Abeno-ku, Osaka 545-8586, Japan

Summary The authors describe a new surgical technique to minimise the

postoperative recurrence of adhesion after microlysis of adhesion

to treat syringomyelia associated with spinal adhesive arachnoiditis. A 47

year old male presented with numbness of the lower extremities

and urinary disturbance and was demonstrated to have a case of syringomyelia

from C1 to T2 which was thought to be secondary to adhe-sive

spinal arachnoiditis related to a history of tuberculous meningitis.

Following meticulous microlysis of the adhesions, maximal expansion

of a blocked subarachnoid space was performed by expansive duraplasty with a

Gore-Tex surgical membrane, expansive laminoplasty and

multiple tenting sutures of the Gore-Tex graft. Postoperatively, the

syringomyelia had been completely obliterated and improvement of the

symptoms had been also achieved. The technique described may contribute to

improvement of the surgical outcome following arachnoid dis-section

by maintaining continuity of the reconstructed subarachnoid space. © 2001

Harcourt Publishers Ltd

Keywords: adhesive arachnoiditis, arachnoid dissection, expansive duraplasty,

expansive laminoplasty, syringomyelia, tuberculosis,

surgical technique

40

Received 28 August 1998

Accepted 21 March 2000

Correspondence to:Kenji Ohata MD, Department of Neurosurgery,

Osaka City University Medical School, 1-5-7 Asahi-machi, Abeno-ku,

Osaka 545-8586, Japan. Tel.: 81 6 645 2157; Fax: 81 6 647 8065;

E-mail: Kenji.Ohata@...

Fig. 1 Preoperative MR images. Left and centre: sagittal T1 -weighted (left)

and T2 -weighted (centre) images showing a syrinx from C2 to T2 and

obliteration of the subarachnoid space dorsal to the spinal cord from C3 to

C7. Right: axial T1 -weighted image at the level of C7 demonstrating a large

syrinx with a septum inside.