MINIMALLY INVASIVE TREATMENT OF IDIOPATHIC SYRINGOMYELIA USING MYRINGOTOMY T-TUBES: A CASE REPORT AND TECHNICAL NOTE

Abstract

Syringomyelia is characterized by a fluid-filled cavity within the spinal cord. Expansion of the syrinx often results in the clinical course of progressive neurologic deficit. Surgery for syringomyelia generally aims to treat the underlying cause, if it is known. However, little is known about idiopathic syringomyelia, which requires specific management. In our paper, an alternative, minimally invasive treatment option for large symptomatic idiopathic cervicothoracic syrinx is described and discussed. We present a case of a 44-year-old male without a history of spinal cord trauma, infection, or other pathologic processes, who presented for thoracic pain. Due to progressive pain and left leg paresis, magnetic resonance imaging (MRI) was performed and revealed extensive septated syringomyelia from T5 to T7 and hydromyelia cranially. We applied minimally invasive technique for shunting the idiopathic syrinx into the subarachnoid space using two Richards modified myringotomy T-tubes. Postoperative MRI revealed significant decrease in the syrinx size and clinical six-month follow-up showed improvement of clinical symptoms. This minimally invasive treatment of syringomyelia was found to be an effective method for idiopathic septated syrinx, without evident underlying cause. However, long-term follow-up and more patients are necessary for definitive evaluation of this technique.

Keywords: Cerebrospinal fluid shunts; Magnetic resonance imaging; Middle ear ventilation; Syringomyelia.

Fig. 1

(A) Sagittal T2-weighted magnetic resonance imaging (MRI) scan shows extensive syringomyelia from T5 to T7 and consequently hydromyelia cranially, from C5 to T4. The syrinx is separated with horizontal membrane at T6 level into two large compartments; (B) axial T2-weighted MRI scan at T6 level reveals a large syrinx.

Fig. 2

Richards modified myringotomy T-tube; soft silicone, internal diameter 1.32 mm, length 4.8 mm.

Fig. 3

Two Richards modified myringotomy T-tubes are inserted within the myelotomies at T6 level, maintaining the newly created communications from the syrinx to the subarachnoid space.

Fig. 4

(A) Postoperative sagittal T2-weighted magnetic resonance imaging (MRI) scan (one day after surgery) shows significant decrease in the size of both the syrinx and hydromyelia; (B) sagittal T2-weighted SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolution) image; (C) axial T2-weighted MRI scan at T6 level after hemilaminectomy.