Cordectomy for Syringobulbo-Myelia with Sleep Apnea Secondary to a Spinal Extramedullary Tumor: Case report
The case of a 40-year-old man with syringobulbomyelia secondary to an unresectable spinal extramedullary tumor is described. Fifteen years previously, the patient had undergone a T8 through T12 laminectomy for a “benign” spinal cord tumor at another hospital and had become paraplegic; the tumor (neurinoma) had been neglected for 12 years. MRI showed a large thoracolumbar spinal tumor with destruction of the vertebral bodies from T10 to L2, and the syrinx above the tumor extending to the medulla oblongata compressing the 4th ventricle (Figure A, B). Polysomnography showed central, peripheral and mixed type sleep apneas, particularly during REM sleep. After the failure of an attempted syringoperitoneal shunt, cordectomy at the level of T6 was performed with a good result. Postoperative polysomnography showed that the central and mixed type sleep apneas had decreased and that the peripheral apnea had increased. MRI one year after the final operation showed disappearance of the syringobulbia, and reduction of the syrinx up to the level of C5 (Figure C).