Favorable results with syringosubarachnoid shunts for treatment of syringomyelia

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✓ From 1969 to 1979, 20 patients with syringomyelia were treated with a syringosubarachnoid shunt. The principal indications for this procedure were: significant progressive neurological deterioration and absent or minimal tonsillar ectopia. There were 15 patients with idiopathic syringomyelia, four with posttraumatic syringomyelia, and one with syringomyelia secondary to spinal arachnoiditis. The operations were performed with an operating microscope, and attention was directed to preserving the arachnoid membrane to ensure proper placement of the distal end of the shunt in an intact subarachnoid space. In all cases, a silicone rubber ventricular catheter was inserted into the syrinx through a posterior midline myelotomy.

The average follow-up period was 5 years. A favorable result was obtained in 15 of the 20 patients (75%), including an excellent result with improvement of neurological deficit in 11 patients and a good result with cessation of progression in four patients. In the remaining five patients the result was poor with further progression of neurological deficit. A short duration of preoperative symptoms was usually a favorable prognostic feature. Four patients with a history of less than 6 months all had excellent results. Thirteen patients had a syringosubarachnoid shunt only, and all had good or excellent results. Seven patients had other surgical procedures, before, accompanying, or after shunt placement, and two had favorable results. Thus, the syringosubarachnoid shunt is an effective therapeutic modality for many patients with syringomyelia, particularly if there is little or no tonsillar herniation.

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Address reprint requests to: Charles H. Tator, M.D., Division of Neurosurgery, Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.

© AANS, except where prohibited by US copyright law.

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    Operative photographs from a patient with idiopathic syringomyelia. A laminectomy of C-5 and C-6 has been performed, and the dura has been opened and held laterally with sutures. Upper Left: The arachnoid over the myelotomy site is opened. A probe is seen entering the myelotomy site. Upper Right: A Pudenz ventricular catheter, with a ligature 3 cm from its tip, is inserted into the syrinx. Fluid from the syrinx is seen in the catheter with its meniscus approximately 1 cm from the ligature. Lower Left: The distal end of the catheter is placed in the subarachnoid space. Lower Right: In this case, the ligature around the catheter is used to suture the arachnoid over the catheter, thus serving to immobilize the catheter and to close the arachnoid membrane.

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