case_images: PMC11301795_01
case_images: Preoperative radiological findings. (a) A sagittal view of a plain computed tomography scan demonstrates a burst fracture of the L2 vertebra (arrow). Note that the L2 vertebra is narrowing the spinal canal. (b) The sagittal view of T2-weighted magnetic resonance imaging (MRI) shows the formation of a large syrinx in the conus medullaris centered at the L1 level (arrow). Note the high-signal intensity rostral to the syrinx at T11-T12 level (arrowhead). (c) Axial view of T2-weighted MRI at L1 level shows a markedly expanded conus medullaris due to syrinx (arrow). Note the compressed cauda equina around the conus medullaris (arrowhead).
case_images: SNI-15-243-g001.jpg
case_images: PMC11301795_01_SNI-15-243-g001.jpg
case_images: F1
case_images: T2-weighted magnetic resonance imaging (MRI) showed a T12-L1 syrinx, while the cine-MRI showed almost no motion of the CSF around the conus medullaris. The cauda equina was markedly compressed by the expanded conus medullaris syrinx [Figure 1].
case_images: Intraoperative findings. (a) Following the dural opening, the conus medullaris and cauda equina protruded from the dural sac. Note no adhesive arachnoiditis. (b) The conus medullaris was markedly expanded, and the syrinx was permeable. (c) After the insertion of the syringosubarachnoid shunt tube into the syrinx, the conus medullaris rapidly shrank, and the cauda equina was settled into the dural sac. (d) Illustration of operative findings by SK demonstrates the post-SS shunting change in the size of the conus medullaris.
case_images: SNI-15-243-g002.jpg
case_images: PMC11301795_01_SNI-15-243-g002.jpg
case_images: F2
case_images: T12-L2 laminectomy, we found that the dural sac was markedly distended; after opening the dura, the conus/cauda equina protruded from the dural sac under increased pressure [Figure 2]. Through a small incision in the conus, the syrinx was rapidly drained, and a SS shunt was placed.
case_images: Postoperative radiological findings. (a) Sagittal view of T2-weighted magnetic resonance imaging (MRI) shows almost complete disappearance of syrinx in the conus medullaris (arrow). Note the simultaneous disappearance of the high-signal intensity area rostral to the syrinx at the T11- T12 level (arrowhead). (b) Axial view of T2-weighted MRI at L1 level shows a marked shrinkage of conus medullaris after surgery (arrow). Note the resolution of the compression against the cauda equina (arrowhead).
case_images: SNI-15-243-g003.jpg
case_images: PMC11301795_01_SNI-15-243-g003.jpg
case_images: F3
case_images: Two months later, the MR showed that the conus syrinx had completely resolved [Figure 3].