TREATMENT OF POST-TRAUMATIC SYRINGOMYELIA WITH SYRINGO-SUBARACHNOID SHUNT: CASE REPORT

• DOI: https://doi.org/10.22533/at.ed.15951325250213

• Palavras-chave: Syringomyelia; Post-traumatic; Neurosurgery.

• Keywords: Syringomyelia; Post-traumatic; Neurosurgery.

• Abstract:

  Case presentation: A 52-year-old male patient suffered a motorcycle accident in 2005, resulting in a fracture of L1-L2 and hospitalization for 57 days due to ASIA B (level T12) and sphincter impairment. After 4 months of conservative treatment, he improved to ASIA D/E with partial sphincter control. In 2018, he presented motor deficit on the right and was diagnosed with thoracic to lumbar syringomyelia, undergoing surgery with another team, which worsened his symptoms (Frankel B). With physiotherapy, he reached ASIA C/D, but still used a wheelchair. Nine months later, symptoms appeared in his upper limbs and an MRI scan showed syringomyelia throughout his spinal cord. On 11/2023, he was examined with ASIA C, requiring a wheelchair and with severe neuropathic pain and dysautonomia. On 04/2024, he underwent surgery with T4-T5 laminectomy and syringo-subarachnoid shunt. The myelotomy was guided by direct stimulation of the median raphe and microsurgical dissection up to the syringomyelic cavity, with placement of a catheter for external shunting, resulting in improvement in neurological potentials, neuropathic pain and sphincter function. The patient is currently in ASIA D/E, walking with a walker. Discussion: Post-traumatic syringomyelia is a condition where a cavity filled with cerebrospinal fluid forms in the spinal cord after trauma, even without apparent clinical injury. Initial symptoms include pain, dysesthesias, sphincter and autonomic disorders, reflex changes, cramps and muscle spasms. In advanced stages, motor deficits and greater functional dependence occur. The pain is described as burning or stabbing and can worsen with movement or pressure. The condition is rare, but more common after spinal cord injuries (1-7% develop symptomatic syringomyelia), affecting mainly men due to greater exposure to accidents. Diagnosis is made by MRI, and treatment is usually surgical, as conservative treatment tends to lead to neurological deterioration. Surgery results in symptom improvement in approximately 90% of patients. Final comments: The syringo-subarachnoid shunt is described as an effective surgical intervention for the treatment of syringomyelia, as seen in the clinical case presented. The use of intraoperative neurophysiological monitoring is recommended for best results.