1
|
Segura-Lozano MA, Carranza-Rentería O, Velázquez-Delgado G, Munguía-Rodríguez AG. Histochemical Analysis of Altered Arachnoid Tissue in Patients With Paroxysmal Trigeminal Neuralgia With Concomitant Continuous Pain. Cureus 2024; 16:e61502. [PMID: 38855490 PMCID: PMC11156573 DOI: 10.7759/cureus.61502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/11/2024] Open
Abstract
Background Trigeminal neuralgia (TN) is a craniofacial pain characterized by sudden onset, brief, severe, recurrent shooting pain within one or more branches of the trigeminal nerve (CN V). Based on its clinical presentation, TN may be classified as purely paroxysmal or paroxysmal with concomitant continuous pain (CCP), previously known as typical and atypical, respectively. Microvascular decompression (MVD) surgery for releasing the CN V from a neurovascular conflict is an effective and safe treatment for TN. During MVD of patients manifesting TN with CCP, the involvement of an abnormal arachnoid tissue is a common finding. The etiology and pathophysiology behind the appearance of this tissue are unknown; however, it is more commonly found in this variant of the disease. Methods From January 2015 to December 2016, a total of 330 patients diagnosed with TN were evaluated at our clinic. Among them, 31 individuals (9.4%) presented with paroxysmal TN with CCP, with 16 patients (51.6%) undergoing MVD. During surgery, samples of altered arachnoid tissue were collected from five patients and subjected to Hematoxylin-Eosin staining and immunohistochemistry for S100 and CD2 Results In a long-term follow-up, 80% of patients operated by DMV remains pain free. Analysis of biopsies revealed chronic fibrosis (n=4), hyperplasia of neurothelial cells (n=3), dystrophic calcifications (n=1). Immunohistochemistry was positive for S100 (n=3) and CD20 (n=3) inflammatory markers. Conclusion Chronic inflammation in the arachnoid tissue involved in paroxysmal TN with CCP could be a contributor to the pathophysiology of this variant of the disease.
Collapse
|
2
|
Kovalenko RA, Osipova NV, Mineev VA, Mitrofanova LB. Symptomatic arachnoiditis ossificans associated with syringomyelia: a clinical case and a brief literature review. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2023. [DOI: 10.14531/ss2023.1.93-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Objective. To present a clinical case of arachnoiditis ossificans associated with syringomyelia and a brief literature review with an emphasis on its etiology, pathogenesis and methods of diagnosis and treatment.Material and Methods. A clinical case of a 68-year-old patient with symptomatic arachnoiditis ossificans is described. The diagnosis was established on the basis of the results of intraoperative biopsy, histological examination of the resected fragment and confirmed in the postoperative period using CT of the spinal cord, multislice CT myelography, etc. Analysis of the course of the pathology raised the following questions: diagnostic criteria and optimal tactics for treating this disease. A brief review of cases of arachnoiditis ossificans described in the literature for the period from 1982 to the present is given.Results. A review of cases of ossifying arachnoiditis described in the literature showed that today there is no single tactic for diagnosing and treating this disease. In most cases, the diagnosis is established intraoperatively (65 % of analyzed cases). At the preoperative stage, CT provides reliable visualization of ossification. When choosing therapy, it is necessary to be based on the severity of the clinical picture, the degree of ossification of the arachnoid membrane and the presence of concomitant pathology of the affected spinal cord department (such as syringomyelia).Conclusion. The presence of a growing neurological deficit should be considered an indication for surgical treatment of patients with arachnoiditis ossificans. The goals of surgery should include decompression of neural structures and restoration of normal cerebrospinal fluid circulation.
Collapse
Affiliation(s)
- R. A. Kovalenko
- Almazov National Medical Research Centre
2 Akkuratova str., St. Petersburg, 197341, Russia
| | - N. V. Osipova
- Pavlov First Saint Petersburg State Medical University
6–8 L’va Tolstogo str., St. Petersburg, 197022, Russia
| | - V. A. Mineev
- Almazov National Medical Research Centre
2 Akkuratova str., St. Petersburg, 197341, Russia
| | - L. B. Mitrofanova
- Almazov National Medical Research Centre
2 Akkuratova str., St. Petersburg, 197341, Russia
| |
Collapse
|
3
|
Thejeel B, Geannette CS, Roytman M, Pisapia DJ, Chazen JL, Jawetz ST. Patterns of Intrathecal Ossification in Arachnoiditis Ossificans: A Retrospective Case Series. AJNR Am J Neuroradiol 2023; 44:228-234. [PMID: 36635055 PMCID: PMC9891321 DOI: 10.3174/ajnr.a7764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
Arachnoiditis ossificans is an uncommon end-stage appearance of chronic adhesive arachnoiditis. Imaging features of arachnoiditis ossificans are characteristic and should be diagnosed to avoid unnecessary intervention and guide prognosis and management. In this case series, we retrospectively analyzed CT and MR imaging of 41 patients to identify common patterns of intrathecal ossification and present the common etiologies. Thirty-two patients had a confirmed history of spinal instrumentation, 7 were discovered on imaging without prior surgical history, 1 had a history of ankylosing spondylitis, and 1 had trauma. The most frequent site of ossification was at the conus and cauda equina. Four patterns of ossification were identified, including central, nerve root encasing, weblike, and peripheral. Arachnoiditis ossificans is an important, likely under-recognized consideration in patients who present with back pain. Diagnosis can be made readily on CT; MR imaging diagnosis is also possible but may be challenging.
Collapse
Affiliation(s)
- B Thejeel
- From the Department of Radiology and Diagnostic Imaging (B.T.), University of Alberta, Edmonton, Alberta, Canada
| | - C S Geannette
- Department of Radiology and Imaging (C.S.G., J.L.C., S.T.J.), Hospital for Special Surgery, New York, New York
| | - M Roytman
- Department of Radiology (M.R), New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - D J Pisapia
- Department of Pathology and Laboratory Medicine (D.J.P.), Weill Cornell Medicine, New York, New York
| | - J L Chazen
- Department of Radiology and Imaging (C.S.G., J.L.C., S.T.J.), Hospital for Special Surgery, New York, New York
| | - S T Jawetz
- Department of Radiology and Imaging (C.S.G., J.L.C., S.T.J.), Hospital for Special Surgery, New York, New York
| |
Collapse
|
4
|
Steel CJ, Abrames EL, O'Brien WT. Arachnoiditis Ossificans - A Rare Cause of Progressive Myelopathy. Open Neuroimag J 2015; 9:13-20. [PMID: 26401174 PMCID: PMC4578143 DOI: 10.2174/1874440001509010013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/19/2015] [Accepted: 07/27/2015] [Indexed: 12/26/2022] Open
Abstract
Arachnoiditis ossificans is a rare cause of chronic, progressive myelopathy. In contrast to the more common benign causes of meningeal calcification, arachnoiditis ossificans results in replacement of portions of the spinal arachnoid by bone as an end-stage complication of adhesive arachnoiditis. It is usually the sequela of prior trauma or interventional procedures. Prognosis and treatment options depend upon the location and degree of spinal stenosis with thoracic involvement being more common and more severe than lumbar spine involvement. The imaging findings on magnetic resonance imaging may be confusing; however, the findings of intraspinal ossification on computed tomography are characteristics and diagnostic. We present a classic case of arachnoiditis ossificans in an elderly man who presented with progressive myelopathy and a recent fall, along with a review of the literature. The imaging in this case not only identified the characteristic findings of arachnoiditis ossificans but also identified secondary findings of the underlying causative etiology.
Collapse
Affiliation(s)
- Christopher J Steel
- Department of Radiology, David Grant USAF Medical Center, Travis AFB, CA, USA
| | - Erik L Abrames
- Department of Radiology, David Grant USAF Medical Center, Travis AFB, CA, USA
| | - William T O'Brien
- Department of Radiology, David Grant USAF Medical Center, Travis AFB, CA, USA ; Department of Radiology, University of California, Davis School of Medicine, Sacramento, CA, USA
| |
Collapse
|
5
|
Maulucci CM, Ghobrial GM, Oppenlander ME, Flanders AE, Vaccaro AR, Harrop JS. Arachnoiditis ossificans: Clinical series and review of the literature. Clin Neurol Neurosurg 2014; 124:16-20. [DOI: 10.1016/j.clineuro.2014.06.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/09/2014] [Accepted: 06/15/2014] [Indexed: 12/21/2022]
|
6
|
Arachnoiditis ossificans of the thoracic spine. J Clin Neurosci 2013; 21:386-9. [PMID: 24291474 DOI: 10.1016/j.jocn.2013.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 07/12/2013] [Indexed: 01/30/2023]
Abstract
Arachnoiditis ossificans is a rare disorder characterized by the development of calcifications of the arachnoid membrane of the thoracic and lumbar spines. It is an extremely rare cause of spinal canal stenosis and consequent neurological compromise, and its origins and optimal management remain unclear. We review of the literature that illustrates the challenges of diagnosis and treatment of arachnoiditis ossificans. A patient with arachnoiditis ossificans is discussed to illustrate the presentation, treatment, and prognosis of the disease.
Collapse
|
7
|
Abrams J, Li G, Mindea SA, Haynes CM, Cheng I. Arachnoid ossificans containing metaplastic hematopoietic marrow resulting in diffuse thoracic intrathecal cysts and severe myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21 Suppl 4:S436-40. [PMID: 21892775 DOI: 10.1007/s00586-011-2005-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/10/2011] [Accepted: 08/18/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To present a rare case of multiple compressive thoracic intradural cysts with pathologic arachnoid ossification, review the literature and present the surgical options. Few reports have identified the existence of arachnoid calcifications and intrathecal cysts causing progressive myelopathy. The literature regarding each of these pathologies is limited to case reports. Their clinical significance is not well studied, although known to cause neurologic sequelae. METHODS An 81-year-old female clinically presents with rapidly progressive myelopathy. Pre-operative magnetic resonance imaging identified multiple compressive thoracic intrathecal cysts. Surgical exploration and decompression of these cysts identified calcified plaques within the arachnoid. Histopathologic examination revealed fibrocalcific tissue undergoing ossification with bone marrow elements. RESULTS Due to progressive myelopathy, the thoracic cysts were decompressed and calcified plaques were excised, once identified intra-operatively. CONCLUSIONS On last examination, the patient's neurologic status had not improved, but had stabilized. The rate of neurologic improvement from excision and decompression is variable, but it may still be warranted in the face of progressive neurologic deficits.
Collapse
Affiliation(s)
- Joshua Abrams
- Department of Orthopedics, Stanford University Medical Center, Stanford, CA, USA.
| | | | | | | | | |
Collapse
|
8
|
Papavlasopoulos F, Stranjalis G, Kouyialis AT, Korfias S, Sakas D. Arachnoiditis ossificans with progressive syringomyelia and spinal arachnoid cyst. J Clin Neurosci 2007; 14:572-6. [PMID: 17368029 DOI: 10.1016/j.jocn.2006.02.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Revised: 02/14/2006] [Accepted: 02/16/2006] [Indexed: 12/01/2022]
Abstract
We present a 30-year-old man with progressive spastic paraparesis. Spinal imaging revealed extensive calcification of the thoracic cord and cauda equina arachnoid, an intradural extramedullary cyst and evidence of rapidly progressing syringomyelia. Radiological diagnosis was arachnoiditis ossificans and an attempt at surgical decompression was made because of progressive neurologic deterioration. Due to tenacious adhesion of the calcified plaques to the cord and roots, only cyst drainage was achieved; the patient had no clinical improvement. A literature review revealed only two other cases reported in the literature with co-existence of arachnoiditis ossificans and syringomyelia. In none of the previous cases was there an intradural extramedullary arachnoid cyst, nor did the syrinx progress in such a rapid fashion. An attempt is made to explain possible pathophysiological mechanisms leading to this unusual pathology.
Collapse
Affiliation(s)
- F Papavlasopoulos
- Department of Neurosurgery, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
9
|
Domenicucci M, Ramieri A, Passacantilli E, Russo N, Trasimeni G, Delfini R. Spinal arachnoiditis ossificans: report of three cases. Neurosurgery 2004; 55:985. [PMID: 15934184 DOI: 10.1227/01.neu.0000137281.65551.54] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Although the clinical and histological features of the pathological entity of spinal arachnoiditis ossificans (AO) have been established for some time, less attention has been paid to the treatment. We propose a classification of spinal AO evaluating the possibilities and indications for surgical or conservative treatment. CLINICAL PRESENTATION Type III has a lumbar localization, presents with less neurological involvement, and usually requires conservative treatment. In Types I and II, which are usually thoracic, clinical worsening justifies surgical decompression or partial removal, whereas total removal is rarely achievable. INTERVENTION The literature was reviewed, and the reports on three patients were added to the published cases. On the basis of a reappraisal of the computed tomographic and magnetic resonance imaging documentation and the surgical descriptions, the cases of AO were classified into three types: semicircular (Type I), circular (Type II), and englobing the caudal fibers (Type III). The indications for treatment were evaluated in terms of surgical possibilities and outcome. CONCLUSION The classification proposed on the basis of radiological findings allows sufficient clinical differentiation of AO and evaluation of the possibilities for surgical treatment. The latter is conditioned by the type of arachnoiditis, degree of neurological involvement, and presence of any concomitant pathological findings.
Collapse
Affiliation(s)
- Maurizio Domenicucci
- Department of Neurological Sciences (Neurosurgery), Rome University "La Sapienza," Rome, Italy.
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
Spinal arachnoiditis is an insidious disease caused by an inflammatory process of the arachnoid membrane resulting from many possible causes, such as myelograms with oil-based radiographic contract agents and multiple back surgeries. Diagnosis is based on symptoms and magnetic resonance imaging. Arachnoiditis can also mimic the symptoms of other diseases, such as spinal cord tumors, cauda equina syndrome, arachnoiditis ossificans, and syringomyelia. Unfortunately, there is no cure, only treatment of the chronic symptoms. It is an incurable disease that can cause minor to severe symptoms from unexplained rashes to neurologic defects.
Collapse
|
11
|
Faure A, Khalfallah M, Perrouin-Verbe B, Caillon F, Deschamps C, Bord E, Mathe JF, Robert R. Arachnoiditis ossificans of the cauda equina. J Neurosurg Spine 2002; 97:239-43. [PMID: 12296687 DOI: 10.3171/spi.2002.97.2.0239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors describe a case of arachnoiditis ossificans (AO) of the cauda equina. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equina compression, inducing severe neurological deterioration. The authors analyze the clinical symptoms, radiological features, histological data, and treatment options relating to this case and 13 others described in the literature; additionally, they consider the possible mechanisms responsible for ossification of the leptomeninges. Although clustered arachnoidal cells are usually implicated in its pathogenesis, an environment induced by arachnoiditis and disturbed cerebrospinal fluid flow appears to be a more important factor. A therapeutic strategy is proposed for AO for which no effective treatment currently exists.
Collapse
Affiliation(s)
- Alexis Faure
- Department of Neurotraumatology, University Hospital (Hôtel-Dieu), Nantes, France.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Mello LR, Bernardes CI, Feltrin Y, Rodacki MA. Thoracic spine arachnoid ossification with and without cord cavitation. Report of three cases. J Neurosurg 2001; 94:115-20. [PMID: 11147844 DOI: 10.3171/spi.2001.94.1.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracic spine arachnoid ossification is a relatively rare disease that affects mainly women and causes sensory, motor, and sphinctal symptoms associated with inferior limb pain. Based on three cases, the authors comment on pathogenic and surgery-related aspects of the disease. The patient in Case 1 was followed over the course of 23 years. Spinal cavitation is highlighted in Case 2, and yellow, gross, half-ring ossification is described in Case 3. Calcium deposits usually occur in the middle and lower thoracic spine where the majority of trabeculated arachnoid cells are located. Operative treatment does not interrupt the ossification process, which continues over time, causing progressive deterioration in the patient. Spinal cavitation can occur due to spinal cord tethering, stretching, and central cord edema formation, accompanied by cerebrospinal fluid blockage and pulse pressure changes. The results of surgical intervention are poor, offering short-term recovery with later deterioration. Multiple pathogenic factors are involved in this clinical syndrome including metabolic changes.
Collapse
Affiliation(s)
- L R Mello
- Department of Neurosurgery, Universidade Regional da Blumenau, Santa Catarina, Brazil.
| | | | | | | |
Collapse
|
13
|
Manabe Y, Shiro Y, Warita H, Hayashi T, Nakashima H, Abe K. Fluctuating monoplegia due to venous insufficiency by spinal arachnoiditis ossificans. J Neurol Sci 2000; 178:163-6. [PMID: 11018709 DOI: 10.1016/s0022-510x(00)00371-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This is the first report of a patient with venous insufficiency following compressive arachnoiditis ossificans (AO). Symptoms of fluctuating monoplegia and sensory disturbance appeared monthly, lasting several weeks each time. Spinal magnetic resonance imaging (MRI) showed high T2-weighted signal intensity in the posterior portion of the column from T11 to T12 and an intradural lesion with low T2-weighted signal intensity. Neurological function and MRI improved markedly following an operation on AO. The symptoms seen in the present case were due to posterior venous insufficiency following compressive AO.
Collapse
Affiliation(s)
- Y Manabe
- Department of Neurology, Okayama University Medical School, 2-5-1 Shikata-cho, 700-8558, Okayama, Japan.
| | | | | | | | | | | |
Collapse
|
14
|
Slavin KV, Nixon RR, Nesbit GM, Burchiel KJ. Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature. J Neurosurg 1999; 91:223-9. [PMID: 10505510 DOI: 10.3171/spi.1999.91.2.0223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of progressive thoracic myelopathy caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and results of the literature search, they describe a pathological basis for this rare condition, discuss its incidence and symptomatology, and suggest a simple classification for various types of the arachnoid ossification. They also discuss the magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. The particular value of plain computerized tomography, which is highly sensitive in revealing intraspinal calcifications and ossifications, in the diagnostic evaluation of patients with a clinical picture of progressive myelopathy is emphasized.
Collapse
Affiliation(s)
- K V Slavin
- Department of Neurological Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
| | | | | | | |
Collapse
|
15
|
Revilla TY, Ramos A, González P, Alday R, Millán JM. Arachnoiditis ossificans. Diagnosis with helical computed tomography. Clin Imaging 1999; 23:1-4. [PMID: 10332589 DOI: 10.1016/s0899-7071(98)00085-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arachnoiditis ossificans (AO) is a rare entity in which ossification of the leptomeninges occurs. This report illustrates a patient with AO of the cervical and dorsal spine, diagnosed by helical computed tomography with multiplanar reconstruction. It demonstrates the value of computed tomography in diagnosing calcified plaques and the utility of multiplanar reconstruction in giving an exact anatomic reference to neurosurgeon.
Collapse
Affiliation(s)
- T Y Revilla
- Sección de Neurorradiologia, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | |
Collapse
|
16
|
Tseng SH, Lin SM. Surgical treatment of thoracic arachnoiditis with multiple subarachnoid cysts caused by epidural anesthesia. Clin Neurol Neurosurg 1997; 99:256-8. [PMID: 9491300 DOI: 10.1016/s0303-8467(97)00086-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report on a 36 year-old woman who had sensorimotor and sphincter dysfunction 0.5 day after having an epidural anesthesia to deliver her baby. The patients' neurological deficits recovered gradually and she could walk without support 1.5 months after the operation. However, her neurological function deteriorated 4 months after anesthesia and a magnetic resonance imaging (MRI) study revealed spinal arachnoiditis with multiple subarachnoid cysts at the T5-7 levels. Surgical treatment consisted of lysis of adhesions and wide opening of the subarachnoid cysts. Her motor function improved after operation and she could walk without support after a 1 year follow-up. However, her sphincter and sensory abnormalities persisted for the most part. The literature on the surgical treatment of arachnoiditis with myelopathy is reviewed and the surgical indications are discussed.
Collapse
Affiliation(s)
- S H Tseng
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | | |
Collapse
|