PMC4085912_01
Sagittal T2-magnetic resonance imaging showing syringomyelia at presentation to UI neurosurgery. (a) One year after presentation. (b) Five months postoperatively. (c) The syrinx is decreased in size after syrinx-subarachnoid shunt
JCVJS-5-47-g001.jpg
PMC4085912_01_JCVJS-5-47-g001.jpg
F1
Imaging demonstrated a syringohydromyelia extending from the C1 level into the thoracic spine [Figure 1a]. Follow-up MRI demonstrated an increase in the syrinx from the levels of C1-C7 [Figure 1b]. Magnetic resonance imaging of the neuraxis 2 years later demonstrated deflation of syringomyelia from 11 mm width to 3 mm [Figure 1c].
(a) Intraoperative microscope photographs of Case number 1 syrinx-subarachnoid shunt placement. The arachnoid was densely opaque. (b) Opened to initiate lysis of adhesions. (c) The Subarachnoid space was satisfactorily opened. (d) To allow for placement of syrinxsubarachnoid shunt. (e) Subsequent arachnoid closure
JCVJS-5-47-g002.jpg
PMC4085912_01_JCVJS-5-47-g002.jpg
F2
The arachnoid was grossly abnormal and appeared white, opaque, and unusually vascular [Figure 2a]. The dense "arachnoid" was opened and lysis of adhesions was performed [Figure 2b]. The subarachnoid space was opened, allowing placement of a syrinx to subarachnoid shunt [Figure 2c]. A midline myelotomy was performed to expose the syrinx cavity and the syrinx-subarachnoid shunt was then placed and secured [Figure 2d]. The arachnoid membrane was then closed over the shunt tubing [Figure 2e].
PMC4085912_02
Axial noncontrast computerized tomographic images demonstrating aneurysmal subarachnoid hemorrhage in Case number 2. There is massive hemorrhage in the basal cisterns (a), hemorrhage occluding the IVth ventricle (a), and substantial intraventricular hemorrhage (b)
JCVJS-5-47-g003.jpg
PMC4085912_02_JCVJS-5-47-g003.jpg
F3
SAH from a ruptured right superior cerebellar artery aneurysm 8 years prior [Figure 3a and b] treated at our institution. She had been treated via ventriculostomy and coil embolization of her aneurysm and did well.
Cervicothoracic syrinx demonstrated by sagittal T1 precontrast magnetic resonance (MR) (a) sagittal T1 postcontrast MR (b and d) Sagittal T2 MR. (e) Postcontrast images demonstrate significant arachnoid enhancement secondary to arachnoiditis (b and d)
JCVJS-5-47-g004.jpg
PMC4085912_02_JCVJS-5-47-g004.jpg
F4
Neuraxis MR imaging was obtained and demonstrated holocord syringohydromyelia extending from C4 to the conus with arachnoid enhancement on contrast administration [Figure 4].
(a) Intraoperative microscope photographs from Case number 2. The arachnoid was opaque. (b) A syringoperitoneal shunt was placed. (c) The dural closed around the proximal catheter
JCVJS-5-47-g005.jpg
PMC4085912_02_JCVJS-5-47-g005.jpg
F5
T7 and T8 to expose the dura. The arachnoid was thickened, white, and opaque with adhesions to the spinal cord and dorsal nerve roots [Figure 5a]. T7 to expose the syrinx and a catheter was set in place and secured to the pia-arachnoid [Figure 5b]. The dura was closed around the proximal catheter in a standard fashion [Figure 5c].