title: 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.
  
  
  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.
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Morisako
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Takami
authors.forename: Toru
authors.initials: T
authors.lastname: Yamagata
authors.forename: Isao
authors.initials: I
authors.lastname: Chokyu
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tsuyuguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohata