Syringosubarachnoid Shunt Research Articles

Syringosubarachnoid shunt for treatment of syringomyelia.

The experiences with a series of 9 patients with syringomyelia treated by syringosubarachnoid shunt (SSS) are presented. All of the cases were evaluated by myelography, CT scan or MNR. The cases showed satisfactory results which consisted in stabilization of the symptoms (55%) or clinical improvement (44%). These results should be continuously evaluated, due to the short follow-up period and to the variable natural history of the illness. Treatment by SSS is a technique of low morbidity. It is recommended for patients with syringomyelia without significant descent of the tonsils or in those cases where posterior fossa operations have failed to obtain good results.

Syringomyelia in Childhood

Childhood syringomyelia is rare and its clinical symptoms differ from those in adults. From 1982 to 1985, the authors studied 19 children with syringomyelia with high-resolution computed tomography (Siemens Somatom II) and with magnetic resonance imaging (MRI)(0.15 tesla imager, Toshiba MRT 15A). There were 14 patients with spina bifida (eight with meningomyeloceles associated with Chiari malformation, and six with lipomas), four with Chiari malformation (type undetermined) and one with idiopathic syringomyelia. Scoliosis and pes cavus were predominant symptoms. Scoliosis was demonstrable in 80% and pes cavus in 40% of the patients with Chiari malformation and idiopathic syringomyelia. Surgery was performed in four patients with Chiari malformation and in two with lipoma. Five patients were treated with a syringo-subarachnoid shunt and one patient with a syringostomy. Five patients improved neurologically and one remained unchanged. The results indicate that syringomyelia in children is not as rare as previous reports suggest, and should be diagnosed and treated early. MRI appears to be very useful in the diagnosis of this disorder, which, in children, is frequently expressed as scoliosis and pes cavus. Subarachnoid shunting is effective for the patient with Chiari malformation, provided the syrinx is large and associated with swelling of the spinal cord. (Shinkeigeka 27: 973–978, 1987)

両側VA-PICA動脈瘤のcoating後発見された脊髄空洞症の1例

A 37-year old housewife was admitted to our clinic because of dysesthesia in the right arm which had started gradually one month before admission. Approxymately seven months prior to it, she had a bilateral vertebral aneurysmal operation (coating by Biobond and Oxycel)Neurological examination revealed left hemihypesthesia below the C2 level, motor weakness of the left arm and diminished deep tendon reflexes on the left.On bilateral vertebral angiograms before and after the surgery, both aneurysms remained un-changed in size and the main branches of the vertebro-basilar arteries were well visualized.CT scan combined with intrathecal and intraventricular injection of metrizamide revealed an enlarged intramedullary canal down to the midthoracic portion, Th6. The intracranial cisterns were not filled with the metrizamide, except for a part of the cisterna magna.A syringosubarachnoid shunt was made with a silastic catheter using microsurgical techniques. Unfortunately, her complaints and neurological condition did not change for the better.In this paper, the geneses of the communicating syringomyelia in this case are discussed, with particular attention to the possibility of postoperative arachnoiditis at bilateral foramen Luschka and/or subarachnoid adhesion due to SAH. If syringomyelia is caused by the adhesion of the sub-arachnoid space at basal cistern, care should be given to the selection of surgical treatment.

Posttraumatic syringomyelia: the British Columbia experience.

Posttraumatic syringomyelia is an uncommon late complication of spinal cord injury. This study identified nine patients with posttraumatic syringomyelia and examined initial presentation, neurologic status, ability to perform functional activities, and results of treatment. Pain and numbness were the most common presenting symptoms. Motor impairment occurred later but was more disabling. Functional abilities depended mainly on the level of the original spinal cord injury. Three patients were managed conservatively and have had no significant progression of their neurologic deficit. Six patients were managed with syringoperitoneal or syringosubarachnoid shunts. Pain improved most consistently after surgery. Motor power improved less and sensation least. Ability to perform activities of daily living did not significantly change after surgery. Posttraumatic syringomyelia remains a difficult therapeutic problem in the spinal cord-injured population.

Rehabilitative neurosurgery.

The neurosurgical role in rehabilitation rehabilitation was studied. Over a 5-year period, 850 individuals were referred to a rehabilitation center after initial acute care. Surgery was indicated for 66 patients. There were 28 quadriplegic or paraplegic individuals with intractable spasticity. Percutaneous radiofrequency foramenal rhizotomies were found to be 98% effective in relieving posttraumatic spasticity. In 14 patients with cognitive impairment, intellectual improvement had reached a plateau level. These persons underwent computed tomography scanning and cisternography, revealing significant communicating hydrocephalus. After surgical shunt therapy, cognitive improvement was noted in 86%. Nineteen individuals were sent for rehabilitation following spine fracture or progressive quadriplegia; 17 were found to have persistent spinal instability requiring surgical stabilization by fusion. This was successful in all cases without complications. Two persons required decompressive spinal operations, resulting in neurological stabilization or improvement. Five patients developed pain, spasticity, ascending neurological deficit, or autonomic dysreflexia due to posttraumatic syrinx. These symptoms were stabilized or improved following syringosubarachnoid shunting. The authors submit that comprehensive neurosurgical reevaluation is desirable in patients received for rehabilitation. Periodic neurosurgical follow-up is recommended. The neurosurgeon's role is not limited to the acute process.

Treatment of cerebrospinal fluid and syringosubarachnoid shunt infection with systemic and intrathecal antibiotics

We present a case of a patient with two preexisting Silastic syringosubarachnoid shunt catheters who developed Enterobacter meningitis. The infection was treated successfully with systemic and intrathecal antibiotics without removal of the catheters. With careful sequential clinical and laboratory monitoring, even this type of cerebrospinal fluid shunt infection can be eradicated without catheter removal and replacement. (Neurosurgery 17:327-328, 1985)

Favorable results with syringosubarachnoid shunts for treatment of syringomyelia.

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 thearachnoid 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.