Isu T, Iwasaki Y, Akino M, Abe H
Neurol Med Chir (Tokyo). 1989 Aug;29(8):728-34. doi: 10.2176/nmc.29.728.
The surgical approach to syringomyelia is controversial. In this study, the authors evaluated the results of various operative procedures applied in 31 patients with syringomyelia. Syringomyelia was associated with Chiari malformation in 17 cases, with spinal adhesive arachnoiditis in nine, with trauma in three, and with epidural arachnoid cyst in one. One case was idiopathic. A total of 38 operations were performed. Syringosubarachnoid shunting was applied in 17 patients, syringoperitoneal shunting in 11, terminal syringostomy in three, ventriculoperitoneal shunting in three, lumboperitoneal shunting in two, foramen magnum decompression (suboccipital craniectomy plus upper cervical laminectomy) and terminal syringostomy in one, and foramen magnum decompression with syringosubarachnoid shunting in one. The postoperative follow-up period ranged from 2 to 55 months (average, 26 months). Of the 31 patients, 23 showed neurological improvement, five were unchanged, and three deteriorated. Among the last three, one patient with Chiari malformation developed shunt malfunction due to arachnoiditis after syringosubarachnoid shunting. In two patients with syringomyelia secondary to adhesive arachnoiditis, the spinal cord was damaged by extensive separation of the arachnoid membrane at surgery. On the basis of the results in these 31 cases, the authors conclude that syringosubarachnoid shunting is effective for syringomyelia associated with Chiari malformation if syringomyelia is responsible for the clinical symptoms. Post-traumatic syringomyelia and syringomyelia secondary to adhesive arachnoiditis should be treated by syringoperitoneal shunting. If hydrocephalus is present, ventriculoperitoneal shunting is indicated. Finally, terminal syringostomy is no more effective than syringosubarachnoid or syringoperitoneal shunting.
治疗脊髓空洞症的手术方法存在争议。在本研究中，作者评估了31例脊髓空洞症患者接受的各种手术治疗的结果。17例脊髓空洞症与Chiari畸形相关，9例与脊髓粘连性蛛网膜炎相关，3例与外伤相关，1例与硬膜外蛛网膜囊肿相关。1例为特发性。共进行了38次手术。17例患者接受了脊髓蛛网膜下腔分流术，11例接受了脊髓腹腔分流术，3例接受了终丝脊髓造瘘术，3例接受了脑室腹腔分流术，2例接受了腰大池腹腔分流术，1例接受了枕骨大孔减压术（枕下颅骨切除术加颈椎上段椎板切除术）及终丝脊髓造瘘术，1例接受了枕骨大孔减压术及脊髓蛛网膜下腔分流术。术后随访时间为2至55个月（平均26个月）。31例患者中，23例神经功能改善，5例无变化，3例恶化。在最后3例中，1例Chiari畸形患者在脊髓蛛网膜下腔分流术后因蛛网膜炎出现分流故障。2例因粘连性蛛网膜炎继发脊髓空洞症的患者，在手术中因蛛网膜广泛分离导致脊髓损伤。基于这31例患者的结果，作者得出结论：如果脊髓空洞症是导致临床症状的原因，脊髓蛛网膜下腔分流术对与Chiari畸形相关的脊髓空洞症有效。创伤后脊髓空洞症及粘连性蛛网膜炎继发的脊髓空洞症应采用脊髓腹腔分流术治疗。如果存在脑积水，则应行脑室腹腔分流术。最后，终丝脊髓造瘘术并不比脊髓蛛网膜下腔或脊髓腹腔分流术更有效。
