Figure 1: Preoperative spine MRI. (A) Sagittal lumbar T2 image showing extensive subarachnoid hemorrhage with lumbosacral flow void and S1-S2 lipoma; (B) T2 Axial view of large hematoma with significant compression of the lumbar dural sac; (C) T2 sagittal view of thoracic extension of the hematoma, with significant spinal cord compression at D4-D6; (D) Angiography of lumbosacral AVM responsible for hemorrhage prior to embolization.

Figure 2: Syringosubarachnoid shunt with insertion of a T-tube

Figure 3: Illustration of the spinal cord at the level of the syringomyelic cavity and the subarachnoid space. (A) First infusion of mesenchymal stem cells under microsurgical visualization, 1ml (8x106 cells) divided into 5 sections of the syringomyelic cavity, and another 5 ml (4x107 cells) before dural closure of the subarachnoid space; (B) Second infusion after 4 weeks and third infusion after 8 weeks, with lumbar puncture for the infusion of 8 ml (5x107 cells) into the subarachnoid space. (Method based on Park et al) [20].

Figure 4: (A-B) T2 sagittal view of the thoracic spine, showing significant multisegmental adhesive arachnoiditis with syringomyelia at D10, which was operated on and submitted to intracavitary infusion of mesenchymal stem cells; (C-D) T2 axial view of the thoracic spine showing arachnoiditis with anterior and posterior adhesions

Figure 5: Motor evoked potential of right lower limb with 400V precentral gyrus stimulation. (A) Pre MSC infusion, showing minimal residual paravertebral potential and isoelectric silence below the iliopsoas segment; (B) Post MSC infusion, showing significant improvement of wave amplitudes of the paravertebral, iliopsoas, quadriceps, tibial and sacral potentials; paravertebral segment potentials were normal and iliopsoas segment potentials were near normal following treatment. Motor evoked potential of the left inferior limb with 400V stimulation. (C) Pre MSC infusion, showing mild residual paravertebral activity and isoelectric silence below the iliopsoas segment; (D) Improved potential amplitude, with near normal amplitude in the paravertebral and iliopsoas segments and subnormal amplitude starting at the quadriceps

Figure 6: Patient is now able to stand straight with the aids of orthesis