Terminal ventriculostomy as an adjuvant treatment of complex syringomyelia: a case report and review of the literature.

Department

Neurosurgery

Document Type

Article

Abstract

Complex syringomyelia is multifactorial, and treatment strategies are highly individualized. In refractory cases, sectioning of the filum terminale, also known as terminal ventriculostomy, has been described as a potential adjuvant treatment to alleviate syrinx progression. A 10-year-old boy with a history of arachnoiditis presented with complex syringomyelia, progressive lower extremity motor weakness, and spasticity. Previously, he had failed spinal cord detethering and direct syrinx shunting. Imaging studies demonstrated a holocord syrinx extending to the level of his conus medullaris and into the filum terminale. The patient underwent an uncomplicated lumbar laminectomy and transection of the filum terminale. Operative pathologic specimens demonstrated a dilated central canal within the filum. Postoperative imaging demonstrated significant reduction in the diameter of the syrinx. At follow-up, the patient's motor symptoms had improved. Terminal ventriculostomy may be a useful adjuvant in treating caudally placed syringes refractory to other treatments. This procedure carries low neurological risk and involves no hardware implantation. In select cases, terminal ventriculostomy may help preserve neurological function in the face of otherwise progressive syringomyelia.

Medical Subject Headings

Arachnoiditis; Cauda Equina; Child; Humans; Male; Meningitis, Fungal; Neural Tube Defects; Syringomyelia; Ventriculostomy

Publication Date

7-1-2011

Publication Title

Acta neurochirurgica

ISSN

0942-0940

Volume

153

Issue

7

First Page

1449

Last Page

1453

PubMed ID

21523358

Digital Object Identifier (DOI)

10.1007/s00701-011-1020-7

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