Highlights
- •Syringomyelia is a rare but serious complication of tuberculous meningitis.
- •TB syringomyelia is often refractory to both surgical and medical management.
- •Surgery does not have significantly better outcomes than medical management.
Abstract
Determinants of tuberculosis (TB) syringomyelia, its management options and outcomes
are still under investigation. The aim of this study is to present a case of TB syringomyelia
with markedly improved symptoms status-post surgery and to understand the clinical
characteristics and outcomes of 33 TB syringomyelia cases reported in the literature.
Specifically, we examined the differences between patients who were managed medically
and those who underwent surgical intervention. Inclusion criteria for the cases were
(1) syringomyelia caused by TB infection rather than co-occurrence of these conditions,
(2) management protocol described, and (3) post-treatment outcome described. The median
age was 30 years (interquartile range (IQR): 23–40) with 55% males. The median time
between TB onset to syringomyelia diagnosis was 2 years. Nineteen patients were surgically
treated, 11 were medically treated, and 3 received no treatment. Twenty-one patients
showed improvement in at least one prior symptom, but no patient experienced a full
recovery. Those that underwent surgical intervention were more likely to have TB meningitis
(95% vs. 64%, p < 0.05) upon initial TB presentation and have a greater interval between
TB onset and syringomyelia presentation (median of 2.6 vs. 0.33 years, ns). A greater
proportion of the surgically managed patients experienced improvement in any symptom
(74% vs. 45%, ns). Future case-controlled studies with larger sample sizes are required
to validate and further understand the outcomes of surgically-managed TB syringomyelia.
Keywords
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Article info
Publication history
Accepted:
January 29,
2021
Received:
December 15,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
