Treatment Of Syringomyelia Research Articles

A novel scoring system for assessing adult syringomyelia associated with CM I treatment outcomes

A specific scoring system for syringomyelia is lacking. Our objective was to investigate the value of a novel scoring system (Syringomyelia Outcome Scale of Xuanwu hospital, SOS-XW) in assessing surgical outcomes in the treatment of syringomyelia (SM) associated with Chiari malformation type I (CM I). A quantitative evaluation system (SOS-XW) of SM includes 4 parameters: pain (P), sensation (S), movement (M), and syringomyelia tension index (STI). The clinical data of 88 patients with CM I-related syringomyelia treated by foramen magnum and Magendie dredging (FMMD) from January 2018 to January 2019 were retrospectively analysed with a mean follow-up of 14.3months, and the SOS-XW score was used to assess the efficacy. The higher the SOS-XW score, the more severe was the SM and related symptoms. The mean preoperative score was 5.97, and the postoperative score was 2.66. The symptom improvement rates were 77.78% for P, 69.01% for S, 31.82% for M, and 95.06% for the syringomyelia tension index (STI). The symptom improvement rate of the PSM score was weakly correlated with the improvement rate of STI, R2 = 0.0016. The percentage of PSM (P + S + M) improvement was lower in patients with an STI of 0. The postoperative SOS-XW score was positively correlated with the postoperative JOA score, R2 = 0.8314. The positive detection rate of SOS-XW was higher than that of the JOA score. To evaluate the surgical procedure efficacy in the treatment of syringomyelia, the SOS-XW score can provide a more objective, detailed, and comprehensive analysis, especially STI. A reduction in STI is the practical standard for assessing the effectiveness of surgery.

Диагностика и лечение сирингомиелии у собак

This work is devoted to the methods of diagnosis and treatment of syringomyelia in different breeds of dogs. Magnetic resonance imaging is the only and sufficiently effective diagnostic method for making a diagnosis. A small and asymptomatic sirin often does not require treatment, surgical intervention is indicated when analgesics do not eliminate discomfort or in the presence of a neurological deficiency. Medication may be chosen for patients with minor pain. This article was a study of 240 dogs, weighing from 2 to 25 kg, with neurological deficiency, where syringomyelia was the main and secondary pathology, the studied animals were representatives of different dog breeds.

Chiari Type 1 Malformation and Syringomyelia in Children: Classification and Treatment Options.

Chiari type 1 malformation (CIM) is defined as tonsillar ectopia of >5mm, while syringomyelia (SM) is defined as a cerebrospinal fluid (CSF)-filled cavity larger than 3 mm dissecting the spinal cord. Over the last decades, our understanding of these pathologies has grown; however, many controversies still exist almost in every aspect of CIM and SM, including etiology, indication for treatment, timing of treatment, surgical technique, follow-up regime, and outcome. This chapter provides a comprehensive overview on different aspects of CIM and SM and on the still existing controversies, based on the evidence presently available. Future directions for clinical research concerning CIM and SM treatment and outcome are elaborated and discussed as well.

A Shunt Method for the Treatment of Syringomyelia Secondary to Trauma and Tuberculous Meningitis

The pathogenesis and surgical treatment of syringomyelia (SM) secondary to trauma and tuberculous meningitis are not clear. We hypothesize that the main cause of SM is impaired cerebrospinal fluid circulation in the subarachnoid space due to spinal arachnoid adhesion induced by trauma or tuberculous meningitis. Using trans-segmental subarachnoid shuntsurgery, we re-established normal cerebrospinal fluid circulation in the subarachnoid space, which resolved the potential cause of SM formation. This study aimed to evaluate the efficacy of trans-segmental subarachnoid shunt surgery in the treatment of SM secondary to trauma or tuberculous meningitis. A total of 143 patients with SM after trauma and tuberculous meningitis were recruited between September 2014 and February 2017. Among these patients, 64 had posttraumatic SM, including 39 males and 25 females with an age range of 21–65 years and an average age of 40.02 years, and 79 patients had SM secondary to tuberculous meningitis, including 49 males and 30 females with an age range of 23–62 years and an average age of 44.95 years. All patients underwent trans-segmental subarachnoid shunt surgery and were subjected to magnetic resonance imaging (MRI) examination between 6 months and 1 year and between 2 and 2.5 years after surgery. Clinical efficacy was assessed by the Tator method. The main symptoms or signs were evaluated by improvement, stabilizationor aggravation of symptoms. Patients were followed-up twice, once at 6 months to 1 year after surgery and once at 2 to 2.5 years after surgery. A total of 143 patients were followed-up for the first time, among whom, the clinical symptoms were improved in 59 patients(41.26%), stable in 51 patients (35.66%) and aggravated in 36 patients (23.08%). MRI exaination showed that the spinal cord cavities completely disappeared in 27 patients (18.88%), shrank significantly in 71 patients (49.65%), did not change or shrink significantly in 32 patients (22.38%) and expanded in 13 patients (9.09%). A total of 122 patients were followed-up for the second time, and the clinical symptoms were improved in 69 patients (56.56%), stable in 25 patients (20.49%) and aggravated in 28 patients (22.95%). Compared to the condition in the first follow-up, 14 patients who were stable were improved, 5 patients who were aggravated were improved, and the symptoms did not change significantly among other patients. The imaging examination did not show any significant change compared to that of the first follow-up. We suggest that trauma or tuberculous meningitis can induce spinal arachnoid adhesion, leading to impaired cerebrospinal fluid circulation in the subarachnoid space, which then causes SM. Trans-segmental subarachnoid shunt surgery is a noninvasive, safe and effective treatment for SM secondary to trauma and tuberculous meningitis.

Treatment of syringomyelia in patients with arachnopathy within craniovertebral junction

To evaluate postoperative outcomes in patients with syringomyelia following arachnopathy at the craniovertebral level. A retrospective analysis included 27 patients with syringomyelia and arachnopathy within the occipital cistern for the period from 2013 to 2018. Eight patients (29.6%) underwent primary surgery. In this group, 2 patients had arachnopathy following post-traumatic subarachnoid hemorrhage, 1 - after non-traumatic subarachnoid hemorrhage in posterior cranial fossa, 2 - after bacterial meningitis, 3 - the cause was unclear. Nineteenth patients underwent redo surgery after previous procedures on posterior cranial fossa (tumor resection - 3 patients, suboccipital decompression for Chiari malformation - 16 cases). High-resolution MRI with special protocols for analysis of CSF circulation and mobility of brain structures was used to diagnose arachnopathy (phase contrast ECG-synchronized MRI, TrueFISP). Surgeries were aimed at mobilization of cerebellar tonsils and spinal cord and restoration of CSF circulation at the craniovertebral level. One year later, 13 (48.1%) patients noted improvement in their condition, 8 (29.6%) patients - clinical stabilization. In most cases, stabilization or improvement of sensory and coordination disorders. Syringomyelia symptoms progressed in 6 (22.2%) patients. Mean preoperative mJOA score was 11.86±1.24, in a year after surgery - 14.17±1.19. According to MRI data after 1 year, syringomyelia disappeared in 2 patients (7.4%), reduced in 13 (48.1%) cases, remained the same in 9 (33.3%) cases and deteriorated in 3 (11.1%) patients. Vaquero index reduced from 45.5% to 21.6 within a year after surgery. Early postoperative complications occurred in 3 (11.1%) patients: 1 (3.7%) had hydrocephalus and 2 (7.4%) had aseptic meningitis. Modern diagnostic and surgical methods for syringomyelia ensure favorable outcomes in 77.7% of cases.

Syringo-Subarachnoid Shunt Placement: A Minimally Invasive Technique Using Fixed Tubular Retractors-Three Case Reports and Literature Review.

Placement of a syringo-subarachnoid shunt as a surgical management for syringomyelia has been well described in the literature. Good results in terms of clinical and radiological improvement have been documented especially for posttraumatic syringomyelia. Traditionally, this has been performed using open approaches which are fraught with risks of cerebrospinal fluid leak, delayed wound healing, and increased postoperative pain. With the help of minimally invasive techniques that are currently being used to treat various degenerative spinal disorders, most of these complications may be minimized. However, few reports in literature describe similar approaches for accessing intradural intramedullary spinal cord lesions and especially for syringomyelia. Retrospective case review: using a 22-mm tubular retractor, a laminotomy was performed, durotomy done, and spinal cord identified. Myelotomy was performed at the dorsal root entry zone, syrinx visualized and entered, followed by placement of syringo-subarachnoid shunt. Three male patients aged 44, 57, and 37 underwent placement of syringo-subarachnoid shunts using minimally invasive fixed tubular retractors. Indications included posttraumatic or postsurgical spinal cord syrinx. Follow-up period was 1 year in all cases. There were no neurological or technique-related complications. All patients showed clinical improvement upon subsequent follow up. Our clinical experience on the treatment of syringomyelia via a minimally invasive fixed tubular retractor is presented. We find that this is an ideal approach for placement of syringo-subarachnoid shunts, as it provides direct access to the lesion with minimal collateral damage and wound-related complications. 4. Relevant - in demonstrating the effectiveness of an already established procedure through a novel, minimally invasive approach which has the potential to significantly reduce the overall morbidity, in view of the inherent approach-related benefits as compared to conventional open approaches.

DYNAMICS OF MYELOPATHIC SYMPTOMS OF SYRINGOMYELIA ASSOCIATED WITH CHIARI MALFORMATION 1 IN PATIENTS WITH POSTOPERATIVE COLLAPSE OF THE CAVITY

Syringomyelia is a chronic myelopathy with the formation of cavities in the spinal cord. The most common cause of syringomyelia is the obstruction of the cerebrospinal fl uid tract at the craniovertebral junction level in patients with Chiari malformation. The main method of treatment of syringomyelia is surgical, aimed at stopping the progression of the disease. To date, controversial data on the postoperative regression of myelopathic symptoms and factors contributing to a positive clinical outcome are presented in the world literature Goal of the study: to assess the dynamics of myelopathic symptoms of syringomyelia at the postoperative stage.Material and methods.44 patients with syringomyelia associated with Chiari 1 malformation, who underwent decompression of the posterior cranial fossa and had positive postoperative radiological dynamics of the syringomyelitis cavity were included to our retrospective study. Patients were evaluated by clinical and MRI parameters at the preoperative and distant postoperative stages.Results. Analysis of clinical and MRI indicators at the preoperative and remote postoperative stages allowed us to determine the frequency of regression of myelopathic symptoms and to identify it’s main dynamics predictors.

Treatment of Syringomyelia in Patients with Arachnoiditis at the Craniocervical Junction.

Craniocervical junction arachnoiditis (CCJA) is an uncommon cause of syringomyelia. The pathophysiology of syrinx formation is uncertain, and the appropriate management unclear. A series of cases is reported to demonstrate variations in etiology, uniformity of functional cerebrospinal fluid obstruction at the foramen magnum, and results of surgical intervention. We retrospectively analyzed the clinical and radiologic features of a consecutive series of patients treated for syringomyelia related to CCJA. Eight patients (5 male, 28-66 years old) were treated from 2000 to 2016. Magnetic resonance imaging demonstrated cervicothoracic syringomyelia in all cases, with the rostral extension of the syrinx suggesting communication with the fourth ventricle in all but one case. There was reduction of foramen magnum cerebrospinal fluid space in all cases, cerebellar ectopia in 5 cases, and fourth ventricular entrapment in 3 cases. Treatment consisted of posterior fossa decompression with either a GoreTex or pericranial patch graft. Six patients had a fourth-ventricle spinal subarachnoid shunt. Two patients had titanium mesh cranioplasty. The immediate postoperative period was associated with reduction in syrinx cavity size and improvement in neurologic symptoms in all cases. At follow-up 10-60 months postoperatively, 3 patients exhibited recurrence of the syrinx and underwent successful reoperation at the craniocervical junction. One patient with persistence of the inferior component of the syrinx was treated with a syrinx-spinal subarachnoid shunt. Most syrinx cavities associated with CCJA communicate with the fourth ventricle. Posterior fossa decompression and fourth ventricle to spinal subarachnoid space shunting appears a reasonable treatment for this form of syringomyelia.

Surgical treatment of multilevel cervical spondylosis in patients with or without a history of syringomyelia.

Cervical spondylotic myelopathy (CSM) is the commonest spinal cord disease in adults. This paper compares patients who developed CSM after successful treatment of syringomyelia to those with CSM exclusively related to degenerative spinal disease. In this prospective study, 70 consecutive patients with CSM and spondylotic changes in at least three levels underwent 73 operations between 2005 and 2015 (mean follow-up: 39±36months). Patients with treated syringomyelia (group A, n=30) and those without (group B, n=40) were distinguished. Japanese Orthopaedic Association (JOA) and European Myelopathy scores (EMS), Karnofksy scores, and scores for individual symptoms were compared. Long-term outcomes were analyzed with progression-free survival rates. Patients of group A were significantly younger with a significantly longer history and lower functional scores compared to group B. 59 laminectomies C3-C6 plus lateral mass fixations, six ventral decompressions with fusion, and eight combined approaches were performed. In both groups, mean JOA (A 9.5±4.3-10.0±4.7; B 11.3±3.7-12.3±4.3), EMS (A 11.4±2.9-12.0±3.1; B 12.2±3.1-13.5±3.3), and Karnofsky scores (A 59±18-62±18; B 68±13-72±15) increased in the first postoperative year with lower scores in group A throughout. Rates for progression-free survival for 5years were similar in both groups (A 64.2%, B 65.6%). Patients with CSM benefit from decompressive surgery. Surgery should be advocated early for all symptomatic patients with a history of syringomyelia. These patients are at risk for diagnostic delay and worse postoperative results.

Tratamiento de la siringomielia en pacientes con malformación de Chiari y craneosinostosis. Caso clínico y revisión de la bibliografía

Patients with multisutural or single craniosynostosis, often suffer from Chiari malformation and syringomyelia. The surgical management of syringomyelia in these patients is controversial. A 3-year-old girl was referred with complex craniosynostosis that had not been corrected surgically. She was asymptomatic despite the cranial MRI showed a Chiari malformation and one year later she developed a cervico-dorso-lumbar syringomyelia. She underwent a decompressive suboccipital craniectomy but subsequently suffered a worsening of syringomyelia. The intracranial pressure monitoring was pathological so it was decided to perform a decompressive bilateral fronto-parieto-temporal craniotomy and remodeling of the cranial vault, achieving a significant reduction of syringomyelia. After reviewing the literature, it is noted that there is currently no consensus on the treatment of syringomyelia in patients with craniosynostosis and Chiari malformation. Some authors recommend the simultaneous surgical suboccipital and cranial vault decompression, others only decompression of the cranial vault and other enlargement of the posterior fossa with distractors. In cases where the suboccipital decompression was performed first, the syringomyelia was not improved or stabilized. We conclude that the most effective treatment for patients with syringomyelia and craniosynostosis is decompressive remodeling of the cranial vault, as the main cause of syringomyelia is the raised intracranial pressure and lack of skull compliance.

Results of surgical treatment of syringomyelia associated with Chiari 1 malformation. An analysis of 125 cases

The rate of Chiari malformation (CM) in a population ranges from 3 to 8 per 100,000 population. In 62-80% of cases, CM is accompanied by the development of syringomyelia (SM) at various levels. The clinical picture in these patients is a combination of CM and SM manifestations; however, SM symptoms often prevail, which creates some problems in the diagnosis of the disease and in the choice of optimal treatment. On the basis of our own experience of surgical interventions, we aimed to clarify the indications for surgical treatment of SM associated with CM and to determine the optimal amount of surgery and the criteria for evaluation of treatment outcomes. Two hundred twenty five patients with a combination of syringomyelia and Chiari 1 malformation were examined in the period from 2011 to February 2015. Of them, 125 patients were operated on. The mean age of the operated patients was 56±8 years. The mean time from the appearance of the first signs of the disease to surgery was 75±82 months. All operations were performed by a single surgeon. The operations were carried out in the half-sitting (89.6%) or prone (10.4%) position. The operation included sparing suboccipital craniectomy, C1 arch resection, recovery of the cerebrospinal fluid (CSF) circulation along the posterior surface of the cerebellum, and reconstruction of the dura mater in the craniovertebral junction region. Exploration of the arachnoid mater of the cisterna magna after dura opening revealed no arachnopathy in 78 (62.4%) patients (Chiari 0 malformation according to Klekamp). The type 1 arachnopathy (by Klekamp) was detected in 31 patients (24.8%), and the type 2 arachnopathy was observed in 16 (12.8%). The condition of 109 (88%) patients was evaluated one year after the surgery. Sixty one (56%) patients had partial or complete regression of preoperative neurological symptoms. The disease stopped progressing in 44 patients (40%). The disease was progressing in 4 (3.7%) patients. No recurrence of a CSF circulation disturbance at the craniovertebral level was observed during follow-up. Early postoperative complications occurred in 4 (3.2%) patients: wound CSF leakage in 1 (0.8%) patient, acute epidural hematoma in 1 (0.8%) patient, and aseptic meningitis in 2 (1.6%) patients. Temporary deteriorations in the condition (headache worsening, meteosensitivity) were detected in 11 (8.9%) patients. These symptoms regressed by the end of the 1st postoperative month. There were no deaths. The indication for surgery in patients with a combination of CM and SM is the presence of neurological symptoms associated with syringomyelia and their progression as well as headache caused by herniation of the cerebellar tonsils, which significantly deteriorates the patient's quality of life. The main criteria for evaluating the efficacy of treatment include stabilization of the clinical symptoms and/or improvement in the patient condition. Suboccipital craniectomy followed by reconstruction of the dura mater and recovery of the CSF circulation in the craniovertebral region is an effective treatment of syringomyelia associated with Chiari 1 malformation.

Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia

Abnormal posterior fossa cerebrospinal fluid (CSF) collections (PFC) are a constituent feature of several welldescribed disorders [1, 25]. These include retrocerebellar arachnoid cysts and the continuum of Dandy Walker pathology described by Barkovich and coworkers (including Dandy Walker malformation, Dandy Walker variant, and Blake’s pouch cyst) [4]. It is thought that similar to Chiari malformations, posterior fossa cysts adjacent to the foramen magnum can herniate and cause impaction of the foramen magnum. Although rare, such impaction may lead to secondary syringomyelia, probably secondary to obstruction of CSF flow between the posterior fossa and the cervical spinal subarachnoid space [2, 6, 9, 10, 15, 17, 19–21, 23, 24, 26–28]. We report our experience treating two children with PFC causing secondary syrinx and review the literature on this topic.

The fate of syringomyelia after surgical treatment of syringomyelia–Chiari I complex

We read with keen interest the article by Lucchetta et al. [1] about the surgical treatment of an 18-year-old man with symptomatic syringomyelia–Chiari I complex who underwent cranio-cervical decompression with neurological improvement and syrinx shrinkage. The authors conclude that clinical and neuroradiological improvement is uncommon in adult patients and recommend early surgery after diagnosis in order to obtain complete recovery. In fact, the recent neurosurgical literature [2–5] as well our experience [6, 7] does not support the authors’ conclusions on the postoperative outcome of patients with syringomyelia associated with Chiari I malformation. Recent surgical series [2–7] have reported a 70–80% rate of postoperative clinical improvement and a 60–100% rate of syrinx shrinkage after cranio-cervical decompression. According to these results, clinical and neuroradiological improvement after surgery or at least stabilization of the clinical syndrome is the rule. In the small cohort of patients with postoperative syringomyelia persistence, direct fluid diversion of the syrinx becomes necessary [8]. Although the natural history of the Chiari malformation remains elusive, the available data support the authors’ policy toward prompt surgical treatment of patients with symptomatic syringomyelia–Chiari I complex. More controversial is defining the management of asymptomatic and oligosymptomatic patients. Given the satisfactory results we achieved with extra-arachnoidal cranio-cervical decompression without duroplasty, actually we offer surgery also for oligosymptomatic patients with Chiari I malformation and syringomyelia–Chiari I complex [6, 7]. The extra-arachnoidal technique has proved to be a safe, and effective means of treating patients with syringomyelia–Chiari I complex allowing the syrinx to decrease in size or collapse in the majority of cases with an associated improvement in many of the neurological disturbances [6, 7]. In addition, preservation of the arachnoidal layer reduces the risk of postoperative complications, such as hydrocephalus, aseptic meningitis, arachnoiditis and pseudomeningocele. Unfortunately, in the paper of Lucchetta et al. [1] is not clear if arachnoidal dissection was undertaken. Interestingly, the postoperative MRI revealed shrinkage of the syrinx along with a small pseudomeningocele, which is clearly enlarged 1 month after surgery. In fact, pseudomeningocele formation is an underestimated surgical complication [9], which may occur also after duroplasty, as reported in the present case. This occurrence may prevent normalization of CSF flow dynamics at the craniovertebral junction with delayed symptoms recurrence in the postoperative period [9, 10].

The role of lumboperitoneal shunts in the treatment of syringomyelia

OBJECT The role of thecoperitoneal shunts in the management of syringomyelia is not well defined. In this study, the authors analyze the outcome of lumboperitoneal shunt procedures carried out to treat syringomyelia in their institution. METHODS The authors retrospectively reviewed the medical records of 19 patients who underwent lumboperitoneal shunt procedures for syringomyelia. RESULTS The mean follow-up duration was 25 months (range 3-51 months). Of 16 cases followed up, only 5 patients reported clinical improvement in their preoperative symptoms, but of these, 2 had clear radiological evidence of improvement. Three of 6 patients with syringomyelia due to spinal arachnoiditis improved. CONCLUSIONS Lumboperitoneal shunts may lead to useful improvement in the symptoms of a patient with syringomyelia while avoiding the risk of neurological deterioration inherent in myelotomies required for syrinx shunting procedures.

脊髄空洞症を伴った特発性胸椎硬膜内クモ膜嚢胞の診断と治療 : 4症例の経験より

脊髄空洞症を生じ,歩行障害を呈した特発性胸椎硬膜内クモ膜嚢胞は,診断が難しく,治療方法も確立されていない.本論文では,MRI診断における要点と,手術方法について考察を行った.われわれが経験した4症例では,MRI T2強調矢状断像において,脊髄空洞症に近接して,脊髄背側部のクモ膜下腔拡大と,脊髄の前方への偏位圧迫を認めた.この脊髄の形と位置の変化が,特に重要な所見である.上記所見により,クモ膜嚢胞の診断はMRIで可能と考える.神経症状が進行する場合は手術が必要と判断される.われわれは全例にクモ膜嚢胞摘出術を行い,うち1例にはシャント術を追加した.術後全例で脊髄空洞症は縮小し,神経症状の改善を認めた.脊髄空洞症を伴った胸椎硬膜内クモ膜嚢胞に対しては,クモ膜嚢胞摘出術を第一選択とし,脊髄への圧迫が除かれたと判断できる場合は,シャント術は不要と考えられる.

Worsening Myelopathy Masked By Peripheral Nerve Disorders

Background/Objective: Peripheral nerve disorders-whether due to peripheral nerve entrapment or to polyneuropathy—can alter the signs of myelopathy, masking both the sensory loss and distal hyperreflexia. Diagnosis of worsening myelopathy may be missed when there is a coexisting peripheral nerve disorder.Methods: This study is a case description and analysis of 3 consecutive cases identified over 2 years.Results: Three cases were identified in which the diagnosis of worsening myelopathy was missed and treatmentwas delayed because neurologic decline was attributed to a coexisting peripheral nerve disorder. This report describes 2 cases of posttraumatic syringomyelia masked by superimposed peripheral nerve entrapments and 1 case of cervical myelopathy due to cervical spinal stenosis from ossification of the posterior Iongitudinaiiigament masked by diabetic polyneuropathy.Conclusion: lt is important to continually question whether the working diagnosis of peripheral nerve disorder explains t he clinical findings, given neurologic decline; or whether a supe rimposed worsening myelopathy may coexist. Early diagnosis of worsening myelopathy is important, because prompt treatment of syringomyelia and myelopathy due to cervical spinal stenosis may yield better outcomes. Early diagnosis is aided by (a) considering alternative and multiple diagnoses, (b) assessing spinothalamic as weil as posterior column sensation and assessing these sensory modalities for proximal as weil as distal limbs, (c) assessing tendon hyperreflexia of proximal as weil as distallimb muscles, and ( d) utilizing electrodiagnostic tests that can identify myelopathy.

4. 脊髄空洞症の外科的治療(A4 脊椎・脊髄疾患医療の最前線)

4. 脊髄空洞症の外科的治療(A4 脊椎・脊髄疾患医療の最前線)

Pathophysiology and Treatment of Syringomyelia

Learning Objectives:After reading this article, the participant should be able to:1. Identify the clinical characteristics of syringomyelia.2. Describe the diagnostic studies and pathophysiologic concepts related to syringomyelia.3. Recall the pathophysiological basis of treatment options for syring

Transverse microincisions of the outer layer of the dura mater combined with foramen magnum decompression as treatment for syringomyelia with Chiari I malformation.

Numerous surgical procedures have been proposed for treatment of syringomyelia associated with Chiari I malformation, but the optimal treatment has not yet been uniformly standardised. The main aim of the surgical treatment of syringomyelia/Chiari I complex is directed toward restoration of physiological cerebrospinal fluid dynamic at the craniovertebral junction. We report the surgical results of eight patients, affected by syringomyelia and Chiari I malformation, age range from 18 to 62 years, treated by bony foramen magnum decompression combined with transverse microincisions of the outer layer of the dura mater. In an average postoperative follow-up period of two years neurological symptoms and signs improved in seven patients. Postoperative Magnetic Resonance showed a decrease in size of the syrinx in seven patients. These results suggest that foramen magnum decompression combined with transverse microincisions of the outer layer of the dura 1) is an effective and safe treatment option for syringomyelia and Chiari I malformation, 2) corrects the circulatory disturbances of cerebrospinal fluid dynamic, 3) leads to a decrease in size of the syrinx and to a significant improvement in neurological signs and symptoms, 4) avoids complications of intradural approaches and syringosubarachnoid shunting.

Comparison of syringopleural and syringosubarachnoid shunting in the treatment of syringomyelia in children

Case records from the Montreal Children's Hospital containing the diagnosis of shunted syringomyelia were retrospectively reviewed. From 1984 to 1994, 31 patients had their syrinx treated by either syringopleural (19 cases, Group A) or syringosubarachnoid (13 cases, Group B) shunting. One patient was included in both groups. Associated diagnoses included: in Group A, two cases of Chiari I and 14 of Chiari II malformations, 14 cases of shunted hydrocephalus, 13 cases of spina bifida aperta, and three cases of spina bifida occulta; Group B, four cases of Chiari I and two of Chiari II malformations, four cases of shunted hydrocephalus, two cases of spina bifida aperta, and five cases of spina bifida occulta. Eight Group A and six Group B patients had undergone prior posterior fossa decompression. Motor deficits predominated in both groups and arachnoiditis was a uniform operative finding. Neurological follow-up examinations showed 11 Group A patients improved and eight stabilized, whereas on magnetic resonance imaging, 12 cavities appeared to have collapsed, five were markedly reduced, and one had increased. One patient underwent reoperation for pleural effusions and one for shunt displacement. In Group B, one patient improved, eight stabilized, three worsened neurologically, and one was lost to follow-up review. Radiologically, one cavity appeared to have collapsed, six were significantly reduced, two were unchanged, and three had enlarged. The authors conclude that syringopleural shunting is a valuable option for controlling syringomyelia in patients without Chiari malformation or in patients who have previously undergone a craniovertebral decompression or are otherwise asymptomatic from their Chiari malformation.