Resolution of syringohydromyelia with targeted CT-guided epidural blood patching

Case report

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In the scientific literature, syringohydromyelia has only rarely been reported in association with spontaneous intracranial hypotension. Management of the syringohydromyelia in these patients has heretofore involved relatively invasive surgical procedures. The authors report the first case of syringohydromyelia in the setting of intracranial hypotension successfully treated with CT-guided epidural blood patches. This case is important in that it represents a potential minimally invasive treatment strategy. Furthermore, the case also highlights the need to consider spontaneous intracranial hypotension when clinically appropriate as a cause of syrinx in patients with cerebellar tonsillar ectopia, in whom the lesion might otherwise be misclassified as a Chiari I malformation. Finally, the responses to the various attempted treatments offer insight into the pathophysiology of this syringohydromyelia, which may differ from classical models of syrinx formation.

Abbreviation used in this paper: SIH = spontaneous intracranial hypotension.

Article Information

Address correspondence to: Peter G. Kranz, M.D., Box 3808, Erwin Road, Durham, North Carolina 27710. email: peter.kranz@duke.edu.

Please include this information when citing this paper: published online April 29, 2011; DOI: 10.3171/2011.3.JNS102164.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal T2-weighted MR images of the cervical and thoracic spinal cord. A and B: Extensive syringohydromyelia seen at presentation. C and D: Repeated imaging after placement of a syringosubarachnoid shunt demonstrating worsening of the syrinx. E and F: After CT-guided blood patching, there is a marked decrease in the size of the syrinx and elevation of the cerebellar tonsils.

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    Coronal T1-weighted postcontast MR images obtained prior to treatment (A), after syringosubarachnoid shunting (B), and after CT-guided blood patching (C). Smooth dural enhancement (arrows) is seen on pretreatment images. Note also the hyperemia of the pituitary gland and effacement of the suprasellar cistern. The dural enhancement (arrows) persists following syringosubarachnoid shunting (B). Following CT-guided blood patching, there is resolution of dural enhancement (C).

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