I have a condition which in early stages greatly resembles one posted by Annika here some years ago. I had surgery for removal of an arachnoid cyst compressing the right S3 nerve root at the S2 vertebral level. Weeks post-op, after an apparent full recovery of function, neurological symptoms once again appeared with this root, and quickly progressed to a worse situation than I had had pre-op.
Upon re-exploration to fix a suspected csf leak, the nerve was found tethered intradurally to scar tissue, and it is assumed my symptoms are a result of the adhesions and the pulling on the nerve root by ordinary activity. A similar experience occurred after the second surgery, and I am experiencing (among other things) numbness in the S3 dermatome (right), which has progressed quickly in the 7 months post-op from a third surgery, which found substantially more scar tissue than the first re-exploration adhering to multiple sacral nerve roots intradurally. The same recurrence of symptoms in the weeks and months post-op has occurred.
In situations where it may be assumed I have a post-surgical variant of adhesive arachnoiditis, is there any medication or treatment found to improve sensory nerve function, or otherwise arrest the slow loss of the same? The major impact of this is erectile dysfunction and perineal and penile numbness on the right side, and by sensory test has been found to correspond to the right S3 dermatome.
Sorry about your distressing symptoms. Adhesions around the nerve result in severe scarring and nerve disturbances distal to it. Only form of treatment for such condition would be to release the adhesions. The procedure of releasing the adhesions around the nerve is called Neurolysis. With your history, probably Neurolysis was done and again you have developed adhesions. With respect to improving your functions it would require to bypass the scarred region. To be specific probably a nerve graft cable to be used which can connect the proximal end and distal end of the nerve but this procedure means the entire nerve is gone and would take months for the nerve fibres to grow. Further can this procedure be performed within the spinal canal root is questionable.
Was neurolysis performed? My 2nd surgery report does not mention this; it only says numerous adhesions were found, which were carefully released, and that the suspect nerve root was found adhered to the dural wall interiorly. Since this surgery had the justification of exploring to seal a small csf leak, is it possible no neurolysis has been performed on me?
My first thought is that if re-opening the dura requires stitches to re-close it, I am probably no better off regardless as the bulk of the scar tissue found on my 2nd re-opening was on top of/on the sutures used to close the dura previously.
Your first question-
When adhesions were released there should have been a possibility of neurolysis done. It is difficult to come to conclusion whether neurolysis was performed or not.
If there is a rent in dura, it requires to be closed. Durameter is one of the meninges that surround brain and spinal cord.
Predicting adhesions is usually difficult as it is based on body's response which differs from person to person.
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