Syringoperitoneal shunt for treatment of cord cavitation.

Suzuki, Masashi; Davis, Charles H.; Symon, Lindsay; Gentili, François

doi:10.1136/jnnp.48.7.620

Cited by 67 publications

(15 citation statements)

References 23 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Syrinx shunting procedures, which include syringosubarachnoid [51, 52, 53, 54, 55, 56], syringopleural [4], and syringoperitoneal [40, 57, 58, 59, 60, 61]shunts, have also been advocated in many studies, either alone or as adjuvants to posterior fossa decompression [22, 37, 52, 62]. Some authors [51]use them in the case of a Chiari malformation only if a posterior fossa decompression fails.…”

Section: Discussionmentioning

confidence: 99%

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Krieger

McComb

Levy³

1999

Pediatr Neurosurg

131

View full text Add to dashboard Cite

A wide variety of surgical adjuvants to the standard bony decompression have been advocated in the treatment of the Chiari I malformation, especially when the tonsillar herniation is associated with hydrosyringomyelia. These include various shunting procedures, duroplasty, obex plugging, and resection of the cerebellar tonsils. Our practice has been to avoid these adjuvants and to perform a simple limited occipital craniectomy, C₁ laminectomy, and dural opening. The dura mater is left open and overlain with oxidized cellulose. To evaluate the efficacy of this more limited procedure, a retrospective review was performed of the medical records of 31 consecutive patients treated over a 6-year period. Twenty-six (84%) of these patients had an associated spinal cord syrinx; all underwent the same procedure. The follow-up period ranged from 15 to 93 months, with all patients having at least one postoperative magnetic resonance imaging at 6 months. Twenty-three of the 26 patients (88%) who presented with a syrinx had significant resolution of the syrinx on follow-up scans with concomitant improvement of presenting signs and symptoms. Of the remaining 3 patients, 1 had progressive hydrocephalus and received a ventriculoperitoneal shunt, with symptom resolution. In the other 2 patients the syrinx did not diminish; both received syringopleural shunts. Postoperative morbidity includes a 26% incidence of headaches, of which half resolved within 5 days, and only 1 persisted beyond 2 weeks. Nausea and vomiting occurred in 16%. Neither of these figures significantly exceeds those of other large surgical series in which the dura mater was closed with a patch graft. Three patients (10%) did have a postoperative cerebrospinal fluid leak; all responded to bedside suturing without further sequelae. This study indicates that a simple bone removal and open dural decompression of the cervicomedullary junction is a safe, effective operative treatment for Chiari I malformation in children. Shunts, duroplasty, obex plugging, and tonsillar resection offer no benefit regarding the outcome when our series is compared to others in which such adjuvants were used.

show abstract

Section: Discussionmentioning

confidence: 99%

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Krieger

McComb

Levy³

1999

Pediatr Neurosurg

131

View full text Add to dashboard Cite

show abstract

“…Late neurological complications include hydrocephalus, cranial nerve palsies, vascular occlusion, spinal cord and root damage [15]. Syringomyelia is usually a late complication of tuberculous meningitis and there have been a few reports on this subject [1,3,4,6,8,9,11,13,14,15,17,18,19,20].…”

Section: Discussionmentioning

confidence: 99%

“…The present paper aims to present a case who developed post meningitic arachnoiditis resulting in the generation of syringomyelia. Syringomyelia secondary to TB meningitis is an exceedingly rare condition of which the relevant data revealed only 23 cases of this type [1,3,4,6,8,9,11,13,14,15,17,18,19,20]. The radiographic diagnosis is best made by MR. As these cases are usually associated with extensive arachnoid adhesions and multifocal loculations, surgical attempts generally fail to improve the neurological status.…”

Section: Introductionmentioning

confidence: 96%

Syringomyelia - As a Late Complication of Tuberculous Meningitis

Kaynar

Koçer

Gençosmanoğlu

et al. 2000

Acta Neurochirurgica

View full text Add to dashboard Cite

The aim of this paper is to demonstrate the unusual MR features of thoracic syringomyelia following TB meningitis and to discuss the neurosurgical aspect of the treatment of this rare entity. Four years after a TB meningitis episode, a 30 year-old female patient developed a progressive spastic paraparesis. MR studies revealed multiloculated syrinxes throughout the thoracic cord. She had a syringo-subarachnoid shunt with a silastic "T" tube inserted. On the first postoperative day, she showed a dramatic neurological improvement, but unfortunately her paraparesis progressed to the preoperative level within a month despite diminished size of the syrinxes on the control MRI examination. Two and a half years after the operation the patient complained of having a burning type of central pain, and further deterioration in neurological function. Thoracic spinal MRI examination demonstrated enlarged syringomyelic cavities. At the second operation syringo-peritoneal shunt insertion was performed via right T10-11 hemilaminectomy using a "T" tube. At present, 4 months after the second operation, the patient's neurological examination demonstrated decreased spasticity, and improved strength in the legs compared to the preoperative level. MRI is the first choice of investigation in detecting TB related myelopathy as it provides a greater detail of pathological changes within and around the spinal cord such as syrinx formation and arachnoiditis. The MR findings are also helpful in deciding the management and predicting the outcome. Presence of multifocal loculations and arachnoid adhesions is the likely cause of treatment failures and poor prognosis.

show abstract

“…In the past, radiation and chemotherapy were advocated in hopes of curbing a suspected gliotic disorder [5], The cur rent surgical armamentarium includes myelotomy with or without a cyst-subarachnoid 'wick', or lumboperitoneal shunts [9,11,20], cyst-pleural [22] or cyst-peritoneal shunt [8,10], thecoperitoneal shunt [23], suboccipital craniecto my with or without plugging of the obex [6,7,14,21 ], and resection of the filum terminale (terminal ventriculosto my) [24], As we could not demonstrate any hindbrain abnormality in our patients, craniectomy or terminal ven triculostomy did not seem theoretically warranted.…”

Section: Discussionmentioning

confidence: 99%

Syringomyelia of the Distal Spinal Cord in Children

Meltzer¹,

James

Trauner³

et al. 1995

Pediatr Neurosurg

View full text Add to dashboard Cite

The syndrome of syringomyelia in children has been extensively described in the literature and is said to most commonly involve the cervical and thoracic spinal cord. We here present two children who had an unusual constellation of signs and symptoms, characterized by bowel and bladder disturbance in one, and in the other with intermittent paroxysmal severe pain and cramping and flexion of the lower extremities accompanied at times by episodes of incontinence. Both were found on magnetic resonance imaging (MRI) to have a syrinx localized to the most distal cord. This was not associated with Arnold-Chiari malformation, trauma, tumors or any other form of spinal dysraphism. Both patients underwent placement of a syringomyelia-peritoneal shunt with complete resolution of symptomatology. Postoperative MRI revealed a complete collapse of the syringomyelia cavity. In those children presenting with bowel or bladder disturbances, associated or not with intermittent pain, flexion attacks, or cramping in the lower extremities, the differential diagnosis of a syringomyelia of the distal cord should be part of the clinical considerations.

show abstract

Syringoperitoneal shunt for treatment of cord cavitation.

Cited by 67 publications

References 23 publications

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Syringomyelia - As a Late Complication of Tuberculous Meningitis

Syringomyelia of the Distal Spinal Cord in Children

Contact Info

Product

Resources

About