Abstract
Introduction
Arachnoiditis ossificans (AO) associated with syringomyelia (SM) is a rare pathology.
Its clinical and image-based diagnostic features are challenging to identify. Only
a limited number of cases have been published thus far. We present two new cases and
offer a review of the literature.
Materials and Methods
We conducted a systematic literature search using PubMed, Web of Science, and Google Scholar with the following keywords: Arachnoiditis ossificans, leptomeningeal calcification,
and spinal meningeal calcification, in combination with syrinx, syringomyelia, hydromyelia,
cord cavitation, and cystic necrosis of the spinal cord.
Results
AO-SM predominantly affected females (12 F, 7 M), with a mean age of 55.84 ± 14.7
years. The mean follow-up was 14.07 ± 9.01 months postoperatively. The main complaints
included low back pain and progressive para-/tetraparesis, with or without urinary
disturbances. Potentially causative events occurred 25.07 ± 13.75 years prior to diagnosis.
Based on imaging findings, patients primarily experienced thoracic AO-SM. In seven
studies, arachnoid cysts were reported in association with AO-SM. Surgical treatment
mainly involved microsurgical AO resection, shunting, or draining of the SM, along
with duraplasty and cystectomy or fenestration of the arachnoid cyst. A second surgical
intervention was conducted on five patients. Approximately 57% of the patients showed
improvement.
Discussion and Conclusion
AO-SM remains one of the least understood causes of myelopathy. Clinical and imaging
diagnostics continue to pose challenges. Preoperative evaluation using magnetic resonance
imaging (MRI) and native CT may be regarded as the gold standard. CT myelography and,
occasionally, Cine MRI should be considered to determine the best surgical option.
Surgical treatment continues to be a dilemma.
Keywords
arachnoiditis ossificans - CSF block - syringomyelia
