PMC8769421_01
Preoperative sagittal T2-weighted MRI (A-C) demonstrating a huge syrinx from the C7 to L2 level. Preoperative axial T2-weighted MRI at C6 (D) and L3 (E). These images suggest a normal subarachnoid space from the rostral of the C7 level to the caudal of the conus medullaris. MRI: magnetic resonance imaging.
nmccrj-8-419-g001.jpg
PMC8769421_01_nmccrj-8-419-g001.jpg
F1
Magnetic resonance imaging (MRI) showed a huge syrinx formation extending from the C7 to L2 level (Figs. 1A-1C). The subarachnoid space disappeared from C7 to the conus medullaris level and appeared to be unaffected from the rostral of the C7 level and the caudal of the conus medullaris (Figs. 1D and 1E).
(A) Intraoperative photograph of the first operation after dura opening. The whitish thickened arachnoid was identified, which is consistent with the diagnosis of AA. (B-D) Postoperative sagittal T2-weighted MRI shows shrinkage of the syrinx. AA: adhesive arachnoiditis, MRI: magnetic resonance imaging.
nmccrj-8-419-g002.jpg
PMC8769421_01_nmccrj-8-419-g002.jpg
F2
During this operation, the thickened arachnoid, which was consistent with our diagnosis, was detected (Fig. 2A). Postoperative MRI showed a reduction of the syrinx (Figs. 2B-2D), and the spasticity of the bilateral lower extremities was gradually improved.
T2-weighted MRI (A-C) and computed tomography imaging (D) just before the second operation. Sagittal T2-weighted MRI shows the enlarged syrinx (A and B). CSF retention was found to have accumulated at the dorsal side of the cauda equina (B and C) where the tip of the shunt tube was located (D). CSF: cerebrospinal fluid, MRI: magnetic resonance imaging.
nmccrj-8-419-g003.jpg
PMC8769421_01_nmccrj-8-419-g003.jpg
F3
MRI revealed that the syrinx had enlarged (Figs. 3A and 3B). Additionally, CSF retention was found at the dorsal area of the cauda equina where the tip of the shunt tube was located (Figs. 3B-3D).
(A-C) Postoperative MRI confirmed the improvement of the syrinx. MRI: magnetic resonance imaging.
nmccrj-8-419-g004.jpg
PMC8769421_01_nmccrj-8-419-g004.jpg
F4
Postoperative MRI showed the diminished size of the syrinx (Figs. 4A-4C) and her symptoms improved again.