Syringohydromyelia following meningomyelocele surgery: role of metrizamide myelography and computed tomography

Five children developed symptoms attributable to syringohydromyelia several years following neonatal surgery for lumbosacral meningomyelocele. Metrizamide injection followed by computed tomography (CT) was performed in all five patients. In two patients, there was direct opacification of both the subarachnoid space and the syringohydromyelia. In a further two patients, delayed CT demonstrated late opacification of the central cavity from contrast introduced into the subarachnoid space. In the fifth patient via a suboccipital puncture, there was fortuitous filling of a caudally displaced fourth ventricle communicating with a central cavity within the cord, but there was no visualization of the subarachnoid space. Surgery with decompression and plugging of the obex halted the progression of the disease in all the patients.