The etiology of syringomyelia associated with trauma remains unknown. Moreover, no single procedure for the treatment of this entity has been consistently successful, leading to the publication of many alternative procedures. As our surgical procedure of choice, we have selected subarachnoid reconstruction in those cases of traumatic syringomyelia with a tethered spinal cord, in which MRI shows the posterior shift of spinal cord and its attachment to the dura mater. The surgical procedure involves an osteoplastic laminotomy with beads and microsurgical lysis between the dura and the adhesive arachnoid membrane associated with posttraumatic inflammation (i. e., untethering). Then we perform fenestration in the normal arachnoid membrane at the rostral and caudal sites of adhesive arachnoid membrane. An expanded polytetrafluoroethylene sheet (Gore-Tex sheet^[○!R]) is inserted and fixed to the the inner part of the dura mater to maintain CSF flow between the two fenestrations. We have to date performed this subarachnoid reconstruction procedure in two cases of traumatic syringomyelia with a tethered spinal cord. Postoperative neurological deterioration did not occur in either case, and postoperative MRI in both cases demonstrated the collapse of the syrinx. These results suggest that subarachnoid reconstruction should be the procedure of choice for traumatic syringomyelia with a tethered spinal cord.
