OBJECTIVE: Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of cerebrospinal fluid homeostasis. Direct intervention on the syrinx is a difficult choice and should be considered a rescue procedure. Data in the literature examining the various options are scanty, with generally unsatisfying results. We report our experience with shunting of the syrinx into the pleural space. METHODS: Twenty patients with syringomyelia refractory to cerebrospinal fluid flow restoration underwent a procedure for placement of a syringopleural shunt between 1998 and 2008. Modified Japanese Orthopaedic Association Scale scores and magnetic resonance imaging were available for each patient preoperatively and at the latest follow-up evaluation. A 2-tailed Wilcoxon signed-rank test was used for statistical analysis. Com - plications related to the operative procedure and to hardware failure were noted. RESULTS: Nineteen patients were available for follow-up with a mean duration of 37.5 (standard deviation, 31.1) months. The condition of 1 patient deteriorated, 2 remained stable, and the remainder improved. The overall mean improvement on the Modified Japanese Orthopaedic Association Scale was 19.5% (95% confidence interval, 8.5–30.5). The median improvement was 4 points on the 17-point scale. Results were statistically significant (P 0.001). Follow-up magnetic resonance imaging showed syrinx collapse in 17 cases and marked shrinkage in 2 cases. Except for 1 case of meningitis followed by fatal pulmonary embolism, no significant complications were noted. CONCLUSION: A syrinopleural shunt should, in our view, be the syrinx diversion procedure of choice. More series of institutional experiences with a homogeneous approach would be helpful to verify this recommendation.

Syringopleural shunt as a rescue procedure in patient with syringomyelia refractory to restoration of cerebrospinale fuid flow / F. Cacciola; M. Capozza; P. Perrini; N. Benedetto; N. Di Lorenzo. - In: NEUROSURGERY. - ISSN 0148-396X. - STAMPA. - 65:(2009), pp. 471-476.

Syringopleural shunt as a rescue procedure in patient with syringomyelia refractory to restoration of cerebrospinale fuid flow

CACCIOLA, FRANCESCO;CAPOZZA, MATTEO;PERRINI, PAOLO;BENEDETTO, NICOLA;DI LORENZO, NICOLA
2009

Abstract

OBJECTIVE: Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of cerebrospinal fluid homeostasis. Direct intervention on the syrinx is a difficult choice and should be considered a rescue procedure. Data in the literature examining the various options are scanty, with generally unsatisfying results. We report our experience with shunting of the syrinx into the pleural space. METHODS: Twenty patients with syringomyelia refractory to cerebrospinal fluid flow restoration underwent a procedure for placement of a syringopleural shunt between 1998 and 2008. Modified Japanese Orthopaedic Association Scale scores and magnetic resonance imaging were available for each patient preoperatively and at the latest follow-up evaluation. A 2-tailed Wilcoxon signed-rank test was used for statistical analysis. Com - plications related to the operative procedure and to hardware failure were noted. RESULTS: Nineteen patients were available for follow-up with a mean duration of 37.5 (standard deviation, 31.1) months. The condition of 1 patient deteriorated, 2 remained stable, and the remainder improved. The overall mean improvement on the Modified Japanese Orthopaedic Association Scale was 19.5% (95% confidence interval, 8.5–30.5). The median improvement was 4 points on the 17-point scale. Results were statistically significant (P 0.001). Follow-up magnetic resonance imaging showed syrinx collapse in 17 cases and marked shrinkage in 2 cases. Except for 1 case of meningitis followed by fatal pulmonary embolism, no significant complications were noted. CONCLUSION: A syrinopleural shunt should, in our view, be the syrinx diversion procedure of choice. More series of institutional experiences with a homogeneous approach would be helpful to verify this recommendation.
65
471
476
F. Cacciola; M. Capozza; P. Perrini; N. Benedetto; N. Di Lorenzo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2158/360394
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