Surgical Treatment of Syringomyelia with Syringopleural Shunting

Abstract

The clinical course of 21 patients who underwent syringopleural shunting for syringomyelia is summarised. All the patients were continuing to deteriorate at the time of the operation. Objective improvement was seen in nine patients following the procedure but three subsequently deteriorated. Contralateral syrinx symptoms have appeared in two patients. No change was seen in six patients who did not deteriorate later. Three were worse following the procedure. In syringomyelia with marked hydrocephalus, ventricular drainage by a valved shunt may be the preferred first procedure. Craniovertebral decompression is recommended for syringomyelia with hindbrain herniation without dense arachnoiditis. In appropriate cases syringopleural shunting may be performed in combination with craniovertebral decompression, and may be the procedure of choice in cases with marked hindbrain arachnoiditis. In cases with a sizeable syrinx who have subsequently deteriorated following craniovertebral decompression, syringopleural shunting may be considered the preferred second procedure. Syringopleural shunting is suggested in amenable cases of syringomyelia associated with spinal tumour, trauma or arachnoiditis.

Surgical prognosis in hindbrain related syringomyelia

“…In 1926, Pousepp was the first to try direct shunting of the syrinx cavity. Many publications and discussions about syringostomy or syrinx shunting in hindbrain related syringomyelia followed (8, 9, 24–27). Today, syrinx shunting is usually performed in post‐inflammatory or post‐traumatic disease (28).…”

“…Pathogenesis seems to be complex and different in (Arnold‐) Chiari malformation. “Communicating hypothesis”(1–4) and Williams' hydrodynamic theory (5–9) both requires communication of the fourth ventricle with the central canal. On the contrary, pre‐/and post‐operative phase‐contrast MRI, CINE‐MR and intraoperative ultrasound suggest an occlusion of the foramen magnum by the herniated hindbrain and the ventral position of the lower brain stem.…”

Surgical Management of Syringomyelia Associated with Spinal Adhesive Arachnoiditis, a Late Complication of Tuberculous Meningitis: A Case Report

“…A classic treatment of syringomyelia is direct drainage of the cyst in patients who show symptoms 13). Although direct treatment approaches such as myelotomy have been suggested, such interventions may lead to deterioration in the postoperative neurological conditions owing to direct intervention in the spinal cord and the rate of recurrence after procedures would be very high.…”

Focal adhesive arachnoiditis of the spinal cord: Imaging diagnosis and surgical resolution

“…[34611–19] Basic studies suggest that spinal tissue scarring at the injury site may cause a tethering effect on the spinal cord, which may lead to significant alterations in the spinal cord parenchyma. [13] Altered CSF dynamics may also be a causative factor.…”

“…[12467111517–1929–31] CSF shunting procedures such as syringopleural or syringoperitoneal shunting have been increasingly used. [1–4] However, CSF shunting procedures have shown an unsatisfactory prognosis and high rates of recurrence.…”