PMC5054629_01
Preoperative (a) T1 and (b) T2-weighted sagittal magnetic resonance imaging (MRI) showing mixed signal abnormalities representing syringomyelia with septations extending from T12 to S1 levels, alongside cord tethering and thickening of the filum terminale at the S2 level. Another signal abnormality seen at S2-3 level causing scalloping of the vertebral bodies - isointense on T1 (a) and hyperintense on T2 (b), representing a Tarlov cyst. T1-weighted axial cuts at the L3-4 level (c) highlighting contrast enhancement of a solid component with gadolinium and enlargement of the spinal canal at the S2 level by the Tarlov cyst (d)
SNI-7-708-g001.jpg
PMC5054629_01_SNI-7-708-g001.jpg
F1
Achilles response. A full spine MRI revealed mixed signal abnormalities in the thoracolumbosacral spinal canal representing a T12-S1 syrinx with septations, a tethered cord, and thickened filum terminale [Figure 1].
(a) Observation of a very thinned out dural layer after laminectomy as depicted on durotomy. (b) A midline myelotomy was performed to decompress the syrinx. (c) Closer inspection revealed a yellow colored gliotic encysted space occupying lesion at the caudal end of the myelotomy
SNI-7-708-g002.jpg
PMC5054629_01_SNI-7-708-g002.jpg
F2
During surgery, a L3-4 laminectomy revealed thinned-out dura, and a midline myelotomy decompressed the syringomyelia and revealed a gliotic encysted space occupying lesion that was biopsied [Figure 2].
(a) Represents the thickened filum terminale observed after S1-2 laminectomy, which was divided to untether the cord. (b) The picture shows the relation of the Tarlov cyst with the durotomy (proximal) done for un-tethering. (c) Represents the fenestration of the Tarlov cyst with evacuation of fluid and partial removal of the cyst wall
SNI-7-708-g003.jpg
PMC5054629_01_SNI-7-708-g003.jpg
F3
In addition, through a S1-2 laminectomy, the filum terminale was divided, allowing for dithering of the cord and its proximal migration [Figure 3]. Furthermore, the Tarlov cyst was fenestrated (e.g., cyst fluid was removed along with part of the cyst wall, whereas surgical clips obliterated the communication between the subarachnoid space and the cyst) [Figure 3].