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  • Title: Adhesive arachnoiditis with extensive syringomyelia and giant arachnoid cyst after spinal and epidural anesthesia: a case report.
    Author: Hirai T, Kato T, Kawabata S, Enomoto M, Tomizawa S, Yoshii T, Sakaki K, Shinomiya K, Okawa A.
    Journal: Spine (Phila Pa 1976); 2012 Feb 01; 37(3):E195-8. PubMed ID: 21738091.
    Abstract:
    STUDY DESIGN: A case report of a patient with adhesive arachnoiditis after combined spinal and epidural anesthesia. OBJECTIVE: To report an extremely rare case of paraplegia due to adhesive arachnoiditis with extensive syringomyelia (ES) and a giant anterior arachnoid spinal cyst (AASC) after spinal and epidural anesthesia for obstetric surgery. SUMMARY OF BACKGROUND DATA: Progressive inflammation of the arachnoid mater due to trauma, infection, or hydrocortisone was reported as early as the 1970s. However, coexistence of ES and a giant AASC after spinal and epidural anesthesia is extremely rare. METHODS: A 29-year-old woman suffered from sudden anuresis 5 months after spinal and epidural anesthesia for a cesarean section and subsequently experienced paraplegia and numbness below the chest. Magnetic resonance imaging showed an AASC compressing the spinal cord at T1-T6 and an adhesive lesion at T7. Posterior laminectomy at T6-T7 and adhesiolysis for arachnoid adhesion at T7 were performed. Although there was slight recovery of locomotive function postoperatively, it gradually worsened until 3 years after surgery. Magnetic resonance imaging at that time demonstrated a giant AASC and ES at the lower-thoracic cord. The cord compressed by the AASC became thinner sagittally. Secondary surgery involving posterior laminectomy at T5-T6 and insertion of a cyst-peritoneal shunt into the AASC was performed. RESULTS: The patient could walk without a cane 3 years after the shunt operation, although numbness and motor weakness of the lower extremities remained. Magnetic resonance imaging 3 years after the shunt operation showed a reduction of the AASC and decompression of the cord despite no improvement in ES. CONCLUSION: This is the first report of a patient with a giant AASC and ES caused by spinal and epidural anesthesia. Although the optimal surgical treatment for these conditions remains unclear, shunting of the cyst effectively prevented the progression of symptoms.
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