Focal adhesive arachnoiditis of the spinal cord: Imaging diagnosis and surgical resolution

Abstract

Background:Although adhesive arachnoiditis of the spinal cord can cause progressive symptoms associated with syringomyelia or myelomalacia, its surgical resolution based on the imaging diagnosis is not well characterized. This study aims to describe the use of imaging for the diagnosis of focal adhesive arachnoiditis of the spinal cord and its surgical resolution using microsurgical arachnoidolysis.Materials and Methods:Four consecutive patients with symptomatic syringomyelia or myelomalacia caused by focal adhesive arachnoiditis underwent microsurgical arachnoidolysis. Comprehensive imaging evaluation using constructive interference in steady-state (CISS) magnetic resonance imaging (MRI) or myelographic MR imaging using true fast imaging with steady-state precession (TrueFISP) sequences was included before surgery to determine the surgical indication.Results:In all four patients a focal adhesion was identified at the cervical or thoracic level of the spinal cord, a consequence of infection or trauma. Three patients showed modest or minor improvement in neurological function, and one patient was unchanged after surgery. The syringomyelia or myelomalacia resolved after surgery and no recurrence was noted within the follow-up period, which ranged from 5 months to 30 months.Conclusions:MRI diagnosis of focal adhesive arachnoiditis is critical to determine the surgical indication. Microsurgical arachnoidolysis appears to be a straightforward method for stabilizing the progressive symptoms, though the procedure is technically demanding.

Practical applications of CISS MRI in spine imaging

“…The high CSF-to-soft tissue contrast of CISS allows resolution of fine meningeal adhesions, nerve root displacement and clumping, and subarachnoid scarring. CISS delineates the level and extent of arachnoiditis and demarcates the site of adhesion which is important in planning surgical release [18,19]. CISS can also help differentiate between scarring and tumor in cases of abnormal enhancement (Fig.…”

Spinal arachnoid web—a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population

“…spinal surgery with arachnoid scarring, infections or spinal hemorrhage are often multifocal and diffusely distributed over different spinal levels. In these cases, insufficient symptom amelioration and a high recurrence rate after surgical treatment by adhesiolysis and/or shunting of the associated syrinx is reported [11][12][13][14][15][16][17] . Although our study strongly suggests a favorable longterm outcome with a mean follow-up period of more than 3 years, subsequent studies and continued follow-ups of the so far treated patients are necessary to capture the total rate of recurrences or sequalae.…”

“…Moreover, there is considerable ambiguity regarding the nomenclature of other spinal arachnopathies: Spinal arachnoiditis is used as a generic term for various inflammatory conditions of the arachnoid membrane, including those observed after previous spinal trauma or surgical intervention. 17,23,24 Currently, SAW is not clearly considered as distinct pathological entity, but sometimes considered as a variant of spinal arachnoid cysts 1,25 . However, spinal arachnoid cysts harbor distinct characteristics like the usually well-defined cyst borders, a slower filling of the cyst in CT-myelography or MRI CSF flow imaging and a less focal distortion of the spinal cord without a scalpel sign 1,[25][26][27] .…”

Sudden death and cervical spine: A new contribution to pathogenesis for sudden death in critical care unit from subarachnoid hemorrhage; first report – An experimental study

“…[ 14 ] Although recent advances in the medical and surgical treatment of spinal lesions have led to better outcomes, adhesive arachnoiditis is still one of the most serious conditions. [ 15 ] Having broad knowledge of anatomy is essential for practicing neurosurgery. Certain anatomical structures call for detailed study due to their functional importance.…”