Percutaneous shunt insertion for assessment and treatment of syringomyelia in the radiology department

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The management of syringomyelia is often difficult because of its uncertain pathogenesis and the many therapeutic options available. Many procedures, including foramen magnum decompression, plugging the obex, and various shunting procedures are used with varying success rates. In order to assess both the symptomatic and anatomic responses to the placement of a shunt prior to more invasive placement of syringoperitoneal or syringopleural shunts, we have placed a shunt catheter via a Touhy needle into the syrinx cavity. This was done under local anaesthetic via percutaneous puncture with the patient in the prone position under screening in the X-ray suite. We have performed this procedure in four patients, in one twice. In all patients the symptoms improved. In one of these patients, after two temporary shunt placements, a permanent shunt was placed in situ percutaneously and tunnelled to the pleura. In a second of these patients a standard surgical syringopleural shunt was placed. In a third patient there was some improvement in symptoms but the patient did not wish a permanent shunt. In the fourth patient there was only a transient improvement in symptoms and his permanent shunt was found to be patent.