# Syringomyelia in the Course of Resection of Foramen Magnum Pathology: A Case Report with an Intriguing Therapeutic Solution and Systematic Review

## TL;DR

This paper reports a rare case of syringomyelia after foramen magnum surgery and reviews similar cases, highlighting the need for more research on this postoperative complication.

## Contribution

The paper presents a new case of iatrogenic syringomyelia and systematically reviews existing literature to better understand its occurrence and treatment.

## Key findings

- Syringomyelia was diagnosed in five patients after CNS or spinal procedures, including the reported case.
- Surgical and conservative treatments showed clinical improvement in all cases.
- Interventions on the ventricular system may increase the risk of postoperative syringomyelia.

## Abstract

Introduction: Syringomyelia is a rare disease of the spinal cord, and postoperative syringomyelia is an extremely rare complication. There are very few scientific reports on this subject in the literature, which is why we decided to review them and report our case of a patient after resection of a meningioma of the foramen magnum; we diagnosed syringomyelia in the course of postoperative complications. Methods: PubMed MEDLINE, Scopus, and Web of Science were searched. The PRISMA checklist was followed for a systematic structure. We paid special attention to publications describing syringomyelia only as a complication of invasive procedures and not as a pathology co-occurring with other diseases. In addition, our studies were based exclusively on the adult population. Results: As a result of the literature analysis, we selected 5 papers that met the established criteria, which are case studies describing the 5 patients. In each of them, syringomyelia was diagnosed after a procedure on the central nervous system (or spine). In three papers, it was decided to treat the syringomyelia that developed in this way surgically, and in the remaining two, conservative treatment and adjustment of the already inserted ventriculoperitoneal shunt were performed. The case of a patient described by us after resection of a meningioma of the foramen magnum required surgical treatment of syringomyelia after two years due to significant progression of the syrinx and the occurrence of troublesome clinical symptoms. In all cases described (including ours), significant clinical improvement was ultimately achieved, allowing patients to return to their daily activities. Conclusions: Iatrogenic syringomyelia is an extremely rare complication that is poorly described in the literature. The large heterogeneity and small number of reported cases make it difficult to draw clear conclusions. Further studies and analyses describing this topic are necessary, and will allow for a better understanding of the mechanism and standardized treatment. However, based on our work, we suggest that interventions on the ventricular system in particular may increase the probability of postoperative syringomyelia.