title: Adhesive arachnoiditis with extensive syringomyelia and giant arachnoid cyst after spinal and epidural anesthesia: a case report.
abstract: METHODS
  A case report of a patient with adhesive arachnoiditis after combined spinal and epidural anesthesia.
  
  
  OBJECTIVE
  To report an extremely rare case of paraplegia due to adhesive arachnoiditis with extensive syringomyelia (ES) and a giant anterior arachnoid spinal cyst (AASC) after spinal and epidural anesthesia for obstetric surgery.
  
  
  BACKGROUND
  Progressive inflammation of the arachnoid mater due to trauma, infection, or hydrocortisone was reported as early as the 1970s. However, coexistence of ES and a giant AASC after spinal and epidural anesthesia is extremely rare.
  
  
  METHODS
  A 29-year-old woman suffered from sudden anuresis 5 months after spinal and epidural anesthesia for a cesarean section and subsequently experienced paraplegia and numbness below the chest. Magnetic resonance imaging showed an AASC compressing the spinal cord at T1-T6 and an adhesive lesion at T7. Posterior laminectomy at T6-T7 and adhesiolysis for arachnoid adhesion at T7 were performed. Although there was slight recovery of locomotive function postoperatively, it gradually worsened until 3 years after surgery. Magnetic resonance imaging at that time demonstrated a giant AASC and ES at the lower-thoracic cord. The cord compressed by the AASC became thinner sagittally. Secondary surgery involving posterior laminectomy at T5-T6 and insertion of a cyst-peritoneal shunt into the AASC was performed.
  
  
  RESULTS
  The patient could walk without a cane 3 years after the shunt operation, although numbness and motor weakness of the lower extremities remained. Magnetic resonance imaging 3 years after the shunt operation showed a reduction of the AASC and decompression of the cord despite no improvement in ES.
  
  
  CONCLUSIONS
  This is the first report of a patient with a giant AASC and ES caused by spinal and epidural anesthesia. Although the optimal surgical treatment for these conditions remains unclear, shunting of the cyst effectively prevented the progression of symptoms.
authors: Department of Orthopedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. hirai.orth@tmd.ac.jp
authors: Takashi
authors: T
authors: Hirai
authors: Tsuyoshi
authors: T
authors: Kato
authors: Shigenori
authors: S
authors: Kawabata
authors: Mitsuhiro
authors: M
authors: Enomoto
authors: Shoji
authors: S
authors: Tomizawa
authors: Toshitaka
authors: T
authors: Yoshii
authors: Kyohei
authors: K
authors: Sakaki
authors: Kenichi
authors: K
authors: Shinomiya
authors: Atsushi
authors: A
authors: Okawa
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D016080:Arachnoid Cysts / Q000150:complications* / Q000601:surgery; D001100:Arachnoiditis / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D011247:Pregnancy; D013118:Spinal Cord Diseases / Q000150:complications* / Q000601:surgery; D013595:Syringomyelia / Q000209:etiology* / Q000601:surgery; D000267:Tissue Adhesions / Q000209:etiology* / Q000601:surgery