Kim Seon-Hwan, Choi Seung-Won, Youm Jin-Young, Kwon Hyon-Jo
Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea.
J Korean Neurosurg Soc. 2012 Jul;52(1):58-61. doi: 10.3340/jkns.2012.52.1.58. Epub 2012 Jul 31.
Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures.
近年来已引入多种治疗创伤后脊髓空洞症的外科手术方法，但大多数手术策略都不可靠。我们介绍一种新的分流手术——脊髓蛛网膜下腔-腹腔分流术的概念和技术。一名54岁患者因右侧运动和位置觉进行性减退入住我院。此次入院前16年，他因L1爆裂骨折接受了减压性椎板切除术。近期入院时，全脊柱磁共振成像研究显示存在一个巨大的脊髓空洞，从延髓延伸至L1椎体水平。我们进行了脊髓蛛网膜下腔-腹腔分流术，包括将T形管插入脊髓空洞、蛛网膜下腔和腹腔。术后临床表现和影像学检查结果均有改善。脊髓蛛网膜下腔-腹腔分流术有几个优点。第一，液体可在脊髓空洞、蛛网膜下腔和腹腔之间自由流通。第二，由于T形管的硬脊膜固定很容易，我们可以防止分流导管移位。最后，我们可以轻松进行分流修正，因为T形管只有一个臂插入脊髓内的空洞腔。我们认为该手术是各种分流手术中最有益的方法。
