A 46-year-old man experienced a complete C6 spinal cord injury with minimal recovery. Two years later, he underwent olfactory stem cell injection into the cervical posttraumatic syrinx but developed progressive weakness. A C5 syringo-subarachnoid shunt was placed, but his strength declined further, so he underwent syrinx evacuation. On dural opening, white gelatinous material exuded under pressure (Figure 1). Pockets of similar material were evacuated. Pathology identified respiratory epithelium and seromucinous glands within fibrous stroma (Figure 2). Within 4 months, he regained deltoid and bicep function.
(A) Preoperative and (B) postoperative sagittal MRI with arrows highlighting complex syrinx. Intraoperative photograph of (C) syrinx cavity and (D) mucinous syrinx material.
(A) Amorphous nasal secretion (×200). (B) Cyst wall highlighting ciliated respiratory mucosa in the upper left box, small seromucinous gland in the upper right box, small nerve twigs in the lower right box. (C) H&E (×400). (D) PAS of ciliated respiratory mucosa with goblet cells (×400). (E) H&E (×200). (F) PAS showing small seromucinous gland, duct (×200). (G) S100 showing small nerve twigs in dense fibrous tissue with axons, Schwann cells (×400). (H) Neurofilament (×400). (I) S100 showing Schwann cells (×400). H&E = hematoxylin and eosin; PAS = periodic acid–Schiff.
Olfactory stem cells have been proposed as an experimental treatment for functional improvement after traumatic spinal cord injury; intrathecal administration improved function in 1 patient.1 Although mesenchymal stromal cell injection in syrinx has shown promise in reducing syrinx size and improving function, careful monitoring is needed for potential side effects.2
Author Contributions
J. Rotter: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data; and additional contributions: obtaining patient consent. R. Kumar: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data. C.L. Nesvick: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data. W.E. Krauss: drafting/revision of the article for content, including medical writing for content; study concept or design; analysis or interpretation of data. C. Giannini: drafting/revision of the article for content, including medical writing for content; analysis or interpretation of data. W.O. Tobin: drafting/revision of the article for content, including medical writing for content; study concept or design; and analysis or interpretation of data.
Study Funding
No targeted funding reported.
Disclosure
The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Resident and Fellow Section Editor Whitley Aamodt, MD, MPH.
Teaching slides links.lww.com/WNL/C952
- Received August 5, 2022.
- Accepted in final form April 13, 2023.
- © 2023 American Academy of Neurology
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