Does Myodil introduced for ventriculography lead to symptomatic lumbar arachnoiditis?

Abstract

Although there is a substantial body of evidence implicating Myodil or Pantopaque as a cause of lumbar arachnoiditis, assessment of the clinically based evidence is complicated by the additional potentially causative factors present in a high proportion of cases. These include pre-existing spinal pathology, traumatic lumbar puncture and surgery. The aim of this retrospective study was to attempt to ascertain whether Myodil introduced via ventricular catheter was associated with subsequent development of symptomatic lumbar arachnoiditis. In 222 patients in whom clinical records were reviewed there was no excess of back pain following ventriculography compared to the general population. Myodil ventriculography does not appear to be a major cause of symptomatic lumbar arachnoiditis. Several unavoidable problems with the methodology of this study are discussed.

Granulomatous meningitis as a late complication of iodized oil myelography

“…2 Hill et al carried out a preliminary retrospective study to eliminate confounding factors, such as pre-existing spinal pathology, traumatic lumbar puncture and surgery that may influence arachnoiditis, but its methodological limitations made it difficult to interpret the findings. 9 Therefore, while Myodil ventriculography continued to be regarded as a safe procedure by some, several reports in Japanese reports describe adverse effects of Myodil use. The use of iodized poppy seed oil has been implicated in membranous lipodystrophy-like lesions in the CNS and cavitations in the spinal cord.…”

“…However, some early studies found no adverse effects attributable to the clinical use of iodized oil contrast media like Myodil for myelography 2 . Hill et al carried out a preliminary retrospective study to eliminate confounding factors, such as pre‐existing spinal pathology, traumatic lumbar puncture and surgery that may influence arachnoiditis, but its methodological limitations made it difficult to interpret the findings 9 . Therefore, while Myodil ventriculography continued to be regarded as a safe procedure by some, several reports in Japanese reports describe adverse effects of Myodil use.…”

Asymptomatic thoracic Pantopaque cyst mimicking an intradural extramedullary lipoma on MR images

“…In these circumstances, clinicians may hesitate to provide aggressive surgical removal of these ''silent Pantopaque cyst region.'' Some studies suggest that degenerative disc disease, or minor spine trauma, interaction with blood and exaggerated effect with incomplete removal of contrast medium could have a synergistic role in arachnoiditis [5,11,12]. This means that even though well sealed Pantopaque cysts may not cause any problems for several decades, common [10] 2001 Scattered T2-T10 Surgical decompression with cyst removal (the cyst was found to be of the communicating type and extended from the vertebral levels T7 to T11.…”

Arachnoiditis ossificans of the cauda equina

“…Vascular abnormalities and spinal anesthesia were reported to be factors in 50 and 25% of published cases, respectively, 26 and SAH was reported in extensive AO. 7,8 Spinal cord injury has been proposed as a predisposing factor, despite the frequency of complicated spinal fractures and the rarity of intradural ossification. 7,8 Spinal cord injury has been proposed as a predisposing factor, despite the frequency of complicated spinal fractures and the rarity of intradural ossification.…”