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Duffy M, Baber Y, O'Donnell C. Tension hydrothorax complicating syringopleural shunt for post-traumatic syringomyelia. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00827-2. [PMID: 39060866 DOI: 10.1007/s12024-024-00827-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 07/28/2024]
Abstract
Syringomyelia is a rare phenomenon that is typically associated with Chiari malformations. However, they can occur in the setting of post-traumatic spinal injury. Potential diversion treatments include syringopleural (SPS), syringoperitoneal and syringosubarachnoid shunts. Short-term complications have been reported in the literature, however, long term complications are not well documented. This case report is of a 43-year-old woman found deceased in bed. She had a history of a traumatic spinal injury following a motor vehicle accident 15 years prior to death. This was complicated by a syringomyelia/syrinx requiring a SPS insertion. Post-mortem imaging and autopsy findings demonstrated a large right tension hydrothorax with dense fibrosis of the pleural surfaces, contralateral diffuse alveolar damage lung changes histologically and a patent SPS. Her cause of death was registered as "Right tension hydrothorax and diffuse alveolar damage complicating right syringopleural shunt and thoracic syrinx".
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Affiliation(s)
- Michael Duffy
- Forensic Pathology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Melbourne, 3006, Australia.
| | - Yeliena Baber
- Forensic Pathology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Melbourne, 3006, Australia
| | - Chris O'Donnell
- Forensic Pathology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Melbourne, 3006, Australia
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2
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Moncho D, Poca MA, Rahnama K, Sánchez Roldán MÁ, Santa-Cruz D, Sahuquillo J. The Role of Neurophysiology in Managing Patients with Chiari Malformations. J Clin Med 2023; 12:6472. [PMID: 37892608 PMCID: PMC10607909 DOI: 10.3390/jcm12206472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Chiari malformation type 1 (CM1) includes various congenital anomalies that share ectopia of the cerebellar tonsils lower than the foramen magnum, in some cases associated with syringomyelia or hydrocephalus. CM1 can cause dysfunction of the brainstem, spinal cord, and cranial nerves. This functional alteration of the nervous system can be detected by various modalities of neurophysiological tests, such as brainstem auditory evoked potentials, somatosensory evoked potentials, motor evoked potentials, electromyography and nerve conduction studies of the cranial nerves and spinal roots, as well as brainstem reflexes. The main goal of this study is to review the findings of multimodal neurophysiological examinations in published studies of patients with CM1 and their indication in the diagnosis, treatment, and follow-up of these patients, as well as their utility in intraoperative monitoring.
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Affiliation(s)
- Dulce Moncho
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Maria A. Poca
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Kimia Rahnama
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
| | - M. Ángeles Sánchez Roldán
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
| | - Daniela Santa-Cruz
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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Liu WH, Wang B, Zhang YW, Xu YL, Wang YZ, Jia WQ. Long-term outcome and prognostic factors of syringo-subarachnoid shunt for syringomyelia. J Clin Neurosci 2023; 113:77-85. [PMID: 37224612 DOI: 10.1016/j.jocn.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Syringo-subarachnoid shunt (SSS) is often considered a rescue procedure or a second-line treatment option for syringomyelia. However, the clinical efficacy of SSS in treating this condition remains controversial. OBJECTIVE To evaluate the long-term outcome of the SSS and its relationship with the syrinx area, as well as to investigate the factors that influence the prognosis. METHODS This retrospective study included twenty-seven consecutive patients who underwent SSS between 2014 and 2020. The study evaluated several independent variables such as age, sex, duration of progressive symptoms, morphological characteristics of the syrinx, changes in the syrinx area, and Chiari malformation. The long-term follow-up (>2 years) Japanese Orthopaedic Association (JOA) score was used to assess neurological function and outcome. Statistical analysis was performed using a stepwise logistic regression test. RESULTS All patients were followed up for an average of 48.6 ± 14.8(26.8 to 78.0) months. Follow-up magnetic resonance imaging showed syrinx collapse to different degrees occurred in 96.3% (26 of 27) patients. The JOA score was improvedinonly6patients (22.2%), remained stable in 5 patients (18.5%),and deteriorated in 16 patients(59.3%).A logistic regression test showed that the tension syrinx (odds ratio 0.111) and early shunting intervention (odds ratio 0.138) were favorable independent prognostic factors. CONCLUSIONS It is important to note that the shrinkage of the syrinx does not necessarily translate to an improvement in clinical outcomes. Therefore, the decision to perform SSS should be made with caution and considered as a last resort.
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Affiliation(s)
- Wei-Hao Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yao-Wu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Lun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Zhi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Qing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Soleman J, Roth J, Constantini S. Chiari Type 1 Malformation and Syringomyelia in Children: Classification and Treatment Options. Adv Tech Stand Neurosurg 2023; 48:73-107. [PMID: 37770682 DOI: 10.1007/978-3-031-36785-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Chiari type 1 malformation (CIM) is defined as tonsillar ectopia of >5 mm, 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.
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Affiliation(s)
- Jehuda Soleman
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Pediatric Neurosurgery, Children's University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
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Tonkaz M, Ozpar R, Erkal D, Dogan S, Bayram AS, Gokce S, Hakyemez B. Leptomeningeal pneumocephalus and pneumorrhachis: Signs of pneumothorax in case of syringopleural shunting. Clin Neurol Neurosurg 2021; 209:106933. [PMID: 34520967 DOI: 10.1016/j.clineuro.2021.106933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
In this article, we present a case of leptomeningeal pneumocephalus and pneumorrhachis secondary to pneumothorax that occurred six years after syringopleural shunting.
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Affiliation(s)
- Mehmet Tonkaz
- Department of Radiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Rifat Ozpar
- Department of Radiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Duygu Erkal
- Department of Radiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Seref Dogan
- Department of Neurosurgery, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Ahmet Sami Bayram
- Department of Thoracic Surgery, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Serhat Gokce
- Department of Radiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Bahattin Hakyemez
- Department of Radiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
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Technical Report: Durable efficacy of an endoscope-assisted syringo-panventriculoatrial shunt for concurrent hydrocephalus and syrinx. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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7
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Ajja CT, Chang TF, Ayers E. Recurrent symptomatic pleural effusion from a syringopleural shunt. Proc AMIA Symp 2021; 34:397-398. [PMID: 33953475 DOI: 10.1080/08998280.2020.1871176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
A patient with a syringopleural shunt with dyspnea and cough was found to have a recurrent large pleural effusion. Computed tomography of the thorax revealed the syringopleural shunt catheter abutting the pleural effusion, and beta-2 transferrin was detected in the pleural fluid, suggesting that the recurrent symptomatic pleural effusion was secondary to the syringopleural shunt. Physicians should be cognizant of this potential long-term complication of syringopleural shunts. Management includes revising the shunt with a programmable device or converting it to a syringoperitoneal or syringoarachnoid shunt.
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Affiliation(s)
- Crystal T Ajja
- Department of Internal Medicine-Pediatrics, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Tiffany F Chang
- Department of Internal Medicine-Pediatrics, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Eric Ayers
- Department of Internal Medicine-Pediatrics, Wayne State University/Detroit Medical Center, Detroit, Michigan
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Kleindienst A, Laut FM, Roeckelein V, Buchfelder M, Dodoo-Schittko F. Treatment of posttraumatic syringomyelia: evidence from a systematic review. Acta Neurochir (Wien) 2020; 162:2541-2556. [PMID: 32820376 PMCID: PMC7496040 DOI: 10.1007/s00701-020-04529-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/04/2020] [Indexed: 01/29/2023]
Abstract
Background Following spinal cord injury (SCI), the routine use of magnetic resonance imaging (MRI) resulted in an incremental diagnosis of posttraumatic syringomyelia (PTS). However, facing four decades of preferred surgical treatment of PTS, no clear consensus on the recommended treatment exists. We review the literature on PTS regarding therapeutic strategies, outcomes, and complications. Methods We performed a systematic bibliographic search on (“spinal cord injuries” [Mesh] AND “syringomyelia” [Mesh]). English language literature published between 1980 and 2020 was gathered, and case reports and articles examining syrinx due to other causes were excluded. The type of study, interval injury to symptoms, severity and level of injury, therapeutic procedure, duration of follow-up, complications, and outcome were recorded. Results Forty-three observational studies including 1803 individuals met the eligibility criteria. The time interval from SCI to the diagnosis of PTS varied between 42 and 264 months. Eighty-nine percent of patients were treated surgically (n = 1605) with a complication rate of 26%. Symptoms improved in 43% of patients postoperatively and in 2% treated conservatively. Stable disease was documented in 50% of patients postoperatively and in 88% treated conservatively. The percentage of deterioration was similar (surgery 16%, 0.8% dead; conservative 10%). Detailed analysis of surgical outcome with regard to symptoms revealed that pain, motor, and sensory function could be improved in 43 to 55% of patients while motor function deteriorated in around 25%. The preferred methods of surgery were arachnoid lysis (48%) and syrinx drainage (31%). Conclusion Even diagnosing PTS early in its evolution with MRI, to date, no satisfactory standard treatment exists, and the present literature review shows similar outcomes, regardless of the treatment modality. Therefore, PTS remains a neurosurgical challenge. Additional research is required using appropriate study designs for improving treatment options.
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Affiliation(s)
- Andrea Kleindienst
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany
- Department of Spine Surgery, Krankenhaus Rummelsberg, Schwarzenbruck, Germany
| | | | - Verena Roeckelein
- Department of Spine Surgery, Krankenhaus Rummelsberg, Schwarzenbruck, Germany
| | - Michael Buchfelder
- Department of Spine Surgery, Krankenhaus Rummelsberg, Schwarzenbruck, Germany
| | - Frank Dodoo-Schittko
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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9
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Direct syrinx drainage in patients with Chiari I malformation. Childs Nerv Syst 2019; 35:1863-1868. [PMID: 31152219 DOI: 10.1007/s00381-019-04228-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022]
Abstract
While FMD is, to date, the primary treatment of symptomatic CM I, the treatment of Chiari malformation type I (CM I) associated syrinx remains controversial. In cases of persistent, progressive, or recurrent syrinx following FMD, direct syrinx drainage (DSD) is described as a safe and efficient option, leading to a good clinical and radiological outcome. However, studies at hand mostly include very heterogeneous patient populations, small cohorts, and are of retrospective nature. We provide an overview of the possible indications and outcome for DSD in CM I-associated syrinx. We discuss the different surgical techniques of DSD and review the available literature comparing different DSD techniques. Finally, we discuss the possible complications that might occur after DSD and how they can be prevented.
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10
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Giner J, Pérez López C, Hernández B, Gómez de la Riva Á, Isla A, Roda J. Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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11
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Bonatti HJ, Kurtom KH. A simple technique for thoracoscopic assisted placement of the distal limb of syringopleural shunts. Respir Med Case Rep 2018; 25:235-238. [PMID: 30294540 PMCID: PMC6171048 DOI: 10.1016/j.rmcr.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 11/26/2022] Open
Abstract
Background Syringomyelia is an unusual accumulation of fluid within the spinal cord that may be associated with significant neurologic symptoms. Surgical drainage using various techniques is often required to reduce the intraparenchymal pressure and to alleviate symptoms. Syringopleural shunting seems to produce best results. Patients and methods A simple technique to insert the distal limb of the syringopleural shunt into the pleural space is described in detail. The patient is placed in prone position. The syrinx is accessed from a dorsal incision and the proximal limb is inserted into the fluid cavity. The tube is tunneled through the subcutaneous space laterally and caudally. A 5mm blunt port is inserted lateral to the scapula and advanced under visual control using a 5mm 30° camera through the subcutaneous tissue and muscle and at the upper border of the 5th rib through the intercostals. With ventilation paused, the pleura is penetrated and CO2 is insufflated with a pressure of 8mm mercury. Under visual control the distal limb of the shunt is inserted at the pleural recessus and the tube is directed cranially. Positive airway pressure is applied re-expanding the lung. The trocar is removed from the pleural cavity and the skin is closed with subcuticular sutures. Results The shunt was successfully placed in three consecutive cases including one redo case (1 male, 1 female aged 50 and 51 years with post traumatic syrinx). Postoperative chest x-ray excluded pneumothorax and no chest tube was required. Neurologic improvement was achieved in both patients. Conclusions General surgeons should be familiar with this simple technique similar to laparoscopic assisted placement of distal ventriculoperitoneal shunt catheters into the abdominal cavity.
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Affiliation(s)
| | - Khalid H Kurtom
- Neurological Surgery, University of Maryland Community Medical Group, Easton, MD, USA.,Department of Neurosurgery, University of Maryland School of Medicine, USA
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Liu H, Yang C, Yang J, Xu Y. Pediatric Chiari malformation type I: long-term outcomes following small-bone-window posterior fossa decompression with autologous-fascia duraplasty. Exp Ther Med 2017; 14:5652-5658. [PMID: 29285106 DOI: 10.3892/etm.2017.5211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/03/2017] [Indexed: 12/14/2022] Open
Abstract
Chiari malformation type I (CM-I) is a common hindbrain disorder that is associated with deformity and elongation of the cerebellar tonsils. Although CM-I occurs in both pediatric and adult patients, its prevalence, clinical features and management in the pediatric population are not well defined. The current study evaluated a consecutive case series of 92 children (38 females and 54 males) who were diagnosed with congenital CM-I. All patients underwent small-bone-window posterior fossa decompression with autologous-fascia duraplasty. Clinical and radiological features were analyzed and long-term follow-up data were recorded. Risk factors associated with clinical outcomes were investigated using comprehensive statistical methods. Out of the 92 children, 11 (12.0%) were asymptomatic. Associated ventricular dilation was observed in 24 children (26.1%) and concomitant syringomyelia was observed in 72 children (78.3%). A total of 44 children (47.8%) showed scoliosis on plain films. Follow-up data (mean duration, 88.6 months) were available for all patients. Syringomyelia was absent or markedly reduced in 56 patients (77.8%). Symptoms were alleviated in 66 patients, remained unchanged in 12 patients and progressed in 3 patients. Statistical analysis indicated that the cerebellar tonsillar descent (CTD) grade, basilar invagination and platybasia influenced the clinical outcome (P<0.05). In conclusion, early recognition and surgical treatment of CM-I in pediatric patients can lead to good outcomes. The current results suggested that small-bone-window posterior fossa decompression with autologous-fascia duraplasty was an effective safe treatment option with a low complication rate. High CTD grade, basilar invagination and platybasia were indicated to be predictors of poor clinical prognosis.
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Affiliation(s)
- Hai Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Chenlong Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jun Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Klimov VS, Gulay YS, Evsyukov AV, Moysak GI. [Syringosubarachnoid shunting in treatment of syringomyelia: a literature review and a clinical case report]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:58-65. [PMID: 28665389 DOI: 10.17116/neiro201781358-65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In the article, we describe a clinical case of syringomyelia associated with an Arnold-Chiari type 1 malformation, evaluate the efficacy of syringosubarachnoid shunting, and analyze the literature data of domestic and international researchers involved in investigation and treatment of the pathology. Application of syringosubarachnoid shunting in the described case resulted in a clinical improvement in the form of regression of paresis and hypoesthesia, which demonstrated the efficacy of the shunting technique for correction of the syringomyelia symptoms.
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Affiliation(s)
- V S Klimov
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - Yu S Gulay
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Evsyukov
- Federal Neurosurgical Center, Novosibirsk, Russia
| | - G I Moysak
- Federal Neurosurgical Center, Novosibirsk, Russia
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Canova G, Boaro A, Giordan E, Longatti P. Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature. J Neurol Surg Rep 2017; 78:e59-e67. [PMID: 28428929 PMCID: PMC5393916 DOI: 10.1055/s-0037-1601327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Posttubercular adhesive arachnoiditis is a rare, late complication of tubercular meningitis. Syringomyelia can develop as a consequence of intramedullary cystic lesions and cerebrospinal fluid (CSF) flow disturbance around the spinal cord, even after successful chemotherapy. We reviewed the literature related to posttubercular syringomyelia treatment and suggest a new combined surgical approach. A 25-year-old Nigerian male patient presented with legs numbness, urinary disturbance, and legs weakness. Spinal magnetic resonance revealed a T5-T7 syringomyelia, secondary to adhesive spinal arachnoiditis related to a history of tuberculous meningitis. Adhesiolysis by direct visualization with a flexible endoscope was performed and a handmade S-italic syringe-subdural shunt was placed to restore CSF flow. During the postoperative course, the neurological deficits improved together with the resolution of the syrinx. Long-term magnetic resonance imaging follow-up documented no recurrences or shunt displacements. We suggest that, when antitubercular therapy is not effective to resolve postarachnoiditis syrinx, arachnolysis with a flexible endoscope together with the placement of an S-italic shunt allowed free CSF communication between the syrinx and the subarachnoid space. Furthermore, we support that the use of an s-shaped shunt could prevent displacement or migration of the device and allows an easier revision in case of acute or late complications.
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Affiliation(s)
- Giuseppe Canova
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Alessandro Boaro
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Enrico Giordan
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Pierluigi Longatti
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
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Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. Neurologia 2016; 34:318-325. [PMID: 27939111 DOI: 10.1016/j.nrl.2016.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/30/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Much has been published on syringomyelia related to Chiari malformation. In contrast, little is known about the condition when it is not associated with this malformation, but this presentation of syringomyelia constitutes a different entity and therefore requires specific management. We conducted a literature review to summarise the most accepted and widespread ideas about the pathophysiology, management and other aspects of syringomyelia unrelated to Chiari malformation. DEVELOPMENT We reviewed the most relevant literature on this condition, focusing on the pathophysiology, clinical presentation, diagnosis, and treatment. CONCLUSIONS Syringomyelia unrelated to Chiari malformation is a distinct entity that must be well understood to guarantee correct diagnosis, monitoring, and management. When the disease is suspected, a thorough study should be conducted to identify its aetiology. Treatment must aim to eliminate the cause of the disease; symptomatic treatment should remain a second-line option.
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Fan T, Zhao X, Zhao H, Liang C, Wang Y, Gai Q, Zhang F. Treatment of selected syringomyelias with syringo-pleural shunt: The experience with a consecutive 26 cases. Clin Neurol Neurosurg 2015; 137:50-6. [DOI: 10.1016/j.clineuro.2015.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/09/2015] [Accepted: 06/13/2015] [Indexed: 11/27/2022]
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Summers JC, Vellore Y, Chan PCH, Rosenfeld JV. Intracranial hypotension after syringopleural shunting in posttraumatic syringomyelia: Case report and review of the literature. Asian J Neurosurg 2015; 10:158-61. [PMID: 25972956 PMCID: PMC4421962 DOI: 10.4103/1793-5482.152113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We report a case of a 45-year-old male with a syringopleural shunt who developed intracranial hypotension. The patient presented with 2 weeks history of worsening headache and back pain, on a background of having had a syringopleural shunt inserted for a thoracic posttraumatic syrinx. Computerized tomography imaging of the brain revealed bilateral subdural fluid collections. Magnetic resonance imaging appearances of spinal and intracranial pachymeningeal enhancement confirmed intracranial hypotension. We present a rare case of intracranial hypotension secondary to syringopleural shunting in a patient with posttraumatic syringomyelia.
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Affiliation(s)
- Johanne C Summers
- Department of Neurosurgery, Monash Medical Centre, Victoria, Australia
| | - Yagnesh Vellore
- Department of Neurosurgery, The Alfred Hospital, Victoria, Australia
| | - Patrick C H Chan
- Department of Neurosurgery, The Alfred Hospital, Victoria, Australia ; Department of Surgery, Monash University, Victoria, Australia
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, The Alfred Hospital, Victoria, Australia ; Department of Surgery, Monash University, Victoria, Australia
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Ghobrial GM, Dalyai RT, Maltenfort MG, Prasad SK, Harrop JS, Sharan AD. Arachnolysis or cerebrospinal fluid diversion for adult-onset syringomyelia? A Systematic review of the literature. World Neurosurg 2014; 83:829-35. [PMID: 24980802 DOI: 10.1016/j.wneu.2014.06.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 06/09/2014] [Accepted: 06/24/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify surgical practice patterns in the literature for nonpediatric syringomyelia by systematic review and to determine the following: 1) What is the best clinical practice of cerebrospinal fluid (CSF) diversion to maximize clinical improvement or to achieve the lowest recurrence rate? 2) Does arachnolysis, rather than CSF diversion, lead to prolonged times to clinical recurrence? METHODS A database search comprising PubMed, Cochrane Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane Database of Systematic Reviews was conducted to find pertinent articles on postinfectious, posttraumatic, or idiopathic syringomyelia. RESULTS An advanced PubMed search in August 2012 yielded 1350 studies, including 12 studies meeting Oxford Centre for Evidence-Based Medicine criteria for level IV evidence as a case series, with a total of 410 patients (mean age, 39 years). Data on 486 surgeries were collected. Mean follow-up data were available for 10 studies, with a mean follow-up time of 62 months. On regression analysis, increased age had a significant correlation with a higher likelihood of having clinically significant recurrence on mean follow-up (P < 0.05). The use of arachnolysis in surgery was associated with a longer duration until clinically symptomatic recurrence (P = 0.02). Data on mortality were unavailable. The mean number of surgeries per patient across all studies was 1.20 (range, 0.95-2.00). CONCLUSIONS With postinfectious and posttraumatic etiologies, arachnolysis was the only surgical treatment to have a statistically significant effect on decreasing recurrence rates. More prospective, randomized, controlled studies are required to reach a clear consensus.
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Affiliation(s)
- George M Ghobrial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Richard T Dalyai
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mitchell G Maltenfort
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Srinivas K Prasad
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
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Duddy JC, Allcutt D, Crimmins D, O’Brien D, O’Brien DF, Rawluk D, Sattar MT, Young S, Caird J. Foramen magnum decompression for Chiari I malformation: A procedure not to be underestimated. Br J Neurosurg 2013; 28:330-4. [DOI: 10.3109/02688697.2013.841847] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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