RESUMO
We present a case of a progressive symptomatic intramedullary cyst, diagnosed decades after Lipiodol injection. Lipiodol was originally administered intrathecally for the radiologic diagnosis of spinal masses. A link between the lesion and the history of Lipiodol injection was never suspected. Surgical exploration revealed a membrane above the lesion, separating the intradural space in a cranial and caudal compartment. On the level of the cyst, we identified glassy pearls containing a fatty liquid, compatible with Lipiodol deposits. We hypothesize that the syrinx is secondary to the impact of cerebrospinal fluid pulsations on the reactive membrane and that this membrane originated from an arachnoiditis caused by Lipiodol deposits. Lipiodol was indeed abandoned after it was found to cause arachnoiditis and neurologic sequelae. Despite the cessation of its usage, the causal role of Lipiodol in arachnoiditis and spinal cyst formation should still be considered, as symptoms may arise many years after Lipiodol administration.
Assuntos
Aracnoidite/induzido quimicamente , Aracnoidite/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Óleo Etiodado/efeitos adversos , Siringomielia/induzido quimicamente , Siringomielia/diagnóstico por imagem , Aracnoidite/cirurgia , Meios de Contraste/administração & dosagem , Cistos/induzido quimicamente , Cistos/diagnóstico por imagem , Cistos/cirurgia , Óleo Etiodado/administração & dosagem , Feminino , Humanos , Injeções Espinhais/efeitos adversos , Pessoa de Meia-Idade , Siringomielia/cirurgiaRESUMO
The article generalizes experience in the restoration of vision by direct stimulation of damaged optic nerves after operations for pathological conditions of the chiasmal-sellar region (tumors of the chiasmal-sellar region, optochiasmic arachnoiditis, damage of the optic nerve in the bone canal) in 111 patients. The therapeutic effect was favourable in two thirds of the patients. Indications are determined for the use of the method in various types, duration, and severity of the disease. The use of the method with due regard for the determined indications increases the reliability, degree, and rate of restoration of vision in patients who underwent operation.