Surgical treatment of syringomyelia

Favorable results with syringoperitoneal shunting

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✓ The authors reviewed the clinical findings, radiological evaluation, and operative therapy of 39 patients with syringomyelia. Syringoperitoneal (SP) shunting was used in 15 patients and other procedures were used in 24 patients. Follow-up periods ranged from 1½ to 12 years. During the period of this study, metrizamide myelography in conjunction with early and delayed computerized tomography scanning replaced all other diagnostic procedures in patients with syringomyelia. Preoperative accuracy for the two procedures was 87%.

The most common symptoms were weakness (79%), sensory loss (67%), pain (38%), and leg stiffness (28%). Surgery was most effective in stabilizing or alleviating pain (100%), sensory loss (81%), and weakness (74%); spasticity, headache, and bowel or bladder dysfunction were less likely to be reversed. Approximately 80% of patients with idiopathic and posttraumatic syringomyelia and 70% of those with arachnoiditis improved or stabilized. Better results were obtained in patients with less severe neurological deficits, suggesting the need for early operative intervention. A higher percentage of patients had neurological improvement with SP shunting than with any other procedure, especially when SP shunting was the first operation performed. Patients treated with SP shunts also had the highest complication rate, most often shunt malfunction. These results indicate that SP shunting is effective in reversing or arresting neurological deterioration in patients with syringomyelia.

Article Information

Address reprint requests to: Michael S. B. Edwards, M.D., c/o The Editorial Office, Department of Neurological Surgery, 350 Parnassus, Suite 807, San Francisco, California 94117.

© AANS, except where prohibited by US copyright law.

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Figures

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    Age and sex distribution of 39 patients with syringomyelia.

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    Left: Sagittal reconstruction of postmetrizamide computerized tomography (CT) scan showing tonsillar ectopia in a patient with Chiari I malformation. Right: Axial postmetrizamide CT scan showing an eccentrically placed cervical syrinx.

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    Plain cervical radiograph after percutaneous injection of metrizamide into the syrinx. The syrinx extends from the top of the cervical spinal cord well into the thoracic region. Multiple septations are visible.

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    Sagittal nuclear magnetic resonance image of a patient with a cervical spinal cord syrinx. Arrows indicate rostral and caudal limits of the syrinx.

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    Syrinx end of a syringoperitoneal (SP) shunt. The flexible T-tube arms have multiple drainage holes and can be cut to the desired length. The shunt is brought out through the spinal cord and dura at a right angle and is secured with the suture tab. A metal step-up connector is used to adapt the SP shunt to standard peritoneal shunt tubing.

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    Comparison of preoperative, immediate postoperative, and long-term results according to preoperative neurological deficit. Early postoperative results did not always predict follow-up results at 1 year. The best results were obtained in patients with the mildest preoperative deficits.

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