Comparison of different operative modalities in post-traumatic syringomyelia: preliminary report

Abstract

Post-traumatic syringomyelia (PTS) is a relatively rare, but potentially disastrous, complication of spinal cord injury. Operative treatment by shunting procedures often shows only a short-term improvement, and the rate of recurrence of syringomyelia is high, so different treatment modalities have been used in the last years. The various results are discussed in this analysis. A prospective clinical study was conducted of 30 patients with PTS treated by shunting procedures or with pseudomeningocele over a period of 9 years, and followed with regular clinical and magnetic resonance imaging examinations. Shunting procedures like syringosubarachnoid and syringopleural or -peritoneal shunting showed good results only at the first follow-ups. In our department, we perform an artificial liquor reservoir at the level of the lesion after opening the spinal pathways and arachnoid adhesions at that level. This procedure was performed in 12 patients. Five of these had been previously operated by shunting procedures; all of them had suffered a recurrence of syringomyelia because of internal occlusion. In the group of patients treated by shunting procedures, a neurological improvement was be recorded in five, and a steady state in eight. Five patients showed a further deterioration. The performance of an artificial liquor reservoir to guarantee a free flow of cerebrospinal fluid around the lesion resulted in a neurological improvement in ten patients, with two maintaining a steady state. Our experience is that shunting procedures often show a neurological improvement only in the short term; the rate of recurrence of typical shunting complications is high. The performance of a pseudomeningocele is an encouraging new step in the treatment of PTS. Further long-term follow-up studies are necessary to assess the benefits of this new method.

Treatment of posttraumatic syringomyelia: evidence from a systematic review

“…A CSF leak was reported in 2.9%, a transient neurological deficit in 2.8%, a permanent neurological deficit in 2.5%, and wound complications were reported in 2% of patients. Other [37,38], and Schaan et al in 30 patients [47]. The results are presented in Table 3.…”

“…A combination of both techniques was performed in a minority of patients and was associated with a considerable morbidity (53-75%) [2,37,38]. Schaan et al compared drain placement (N = 18: improvement 33-38%; deterioration 13-31%) and duraplasty (N = 12; improvement 45-100%; deterioration 0-18%) [47].…”

Long-term result of the Echols procedure for treating syringomyelia

“…We report that in this case the method resulted in permanent collapse of the syrinx as assessed by CT-myelography thirty-four years after treatment. The stainless steel wire did not evoke an inflammatory reaction in the surrounding subarachnoid space which compares favorably to silastic catheters which may evoke fibrosis that results in occlusion of the syringe-subarachnoid shunts within the spinal cord or subarachnoid space 30. However, the requirement to penetrate the spinal cord twice with Echols’ technique rather than once with myelotomy and shunting makes Echols’ procedure potentially more likely than shunting to cause injury to the dorsal columns of the spinal cord.…”

Polytetrafluoroethylene sponge syringosubarachnoid shunt.

“…T-catheters are slightly smaller but are suitable only for extraspinal shunting. Postoperative problems with shunt are shunt occlusion, shunt infection, and postshunt arachnoid scarring (1,6,7). Despite these drawbacks, shunting offers the advantages of instantaneous drainage and a straightforward technique.…”