Davidson Keryn A, Rogers Jeffrey M, Stoodley Marcus A
Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Sydney, Australia.
Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Sydney, Australia.
World Neurosurg. 2018 Feb;110:e53-e59. doi: 10.1016/j.wneu.2017.09.205. Epub 2017 Oct 7.
Surgery for syringomyelia generally aims to treat the underlying cause, if it is known. Optimal management is unclear for idiopathic syringomyelia, or when treatment of the putative cause has failed or is high risk. Syrinx to subarachnoid shunting is an option for these cases; a series is reported to assess the outcomes of this approach.
We retrospectively analyzed the clinical and radiologic features of a consecutive series of patients with syringomyelia treated with syrinx to subarachnoid shunting.
Forty-one patients (19 male, 4-79 years old) were treated from 2000 to 2016, including 15 patients with idiopathic syringomyelia, 13 with spinal trauma, 5 with Chiari malformation, 4 with arachnoiditis, 3 with tethered cord, and 1 with arachnoid bands. The patients were treated with a syrinx to subarachnoid shunt, and a subset also underwent expansile duraplasty. At follow-up (3-108 months, mean 36 months) syrinx size was reduced in 37 patients, and there was improvement or stabilization of symptoms in all but 1 patient. Three patients had temporary lower limb sensory symptoms after surgery. Other complications were 2 transient cerebrospinal fluid leaks, a pseudomeningocoele, and 1 postoperative myocardial infarction. Two cases of shunt dislodgement required reoperation, and a third case required early reoperation for an enlarging syrinx. There were no cases of shunt blockage or infection.
Syrinx to subarachnoid shunting is a safe and effective treatment for idiopathic syringomyelia and for patients who are not suitable for, or have not responded to, other treatment.
脊髓空洞症的手术通常旨在治疗已知的潜在病因。对于特发性脊髓空洞症，或当假定病因的治疗失败或风险较高时，最佳治疗方案尚不清楚。对于这些病例，脊髓空洞-蛛网膜下腔分流术是一种选择；本文报告了一组病例以评估该方法的疗效。
我们回顾性分析了一系列连续接受脊髓空洞-蛛网膜下腔分流术治疗的脊髓空洞症患者的临床和影像学特征。
2000年至2016年期间共治疗了41例患者（男性19例，年龄4至79岁），其中15例为特发性脊髓空洞症，13例为脊髓外伤，5例为Chiari畸形，4例为蛛网膜炎，3例为脊髓栓系，1例为蛛网膜带。患者接受了脊髓空洞-蛛网膜下腔分流术，部分患者还接受了扩大硬脑膜成形术。随访（3至108个月，平均36个月）时，37例患者的脊髓空洞大小减小，除1例患者外，所有患者的症状均有改善或稳定。3例患者术后出现短暂的下肢感觉症状。其他并发症包括2例短暂性脑脊液漏、1例假性脑脊膜膨出和1例术后心肌梗死。2例分流器移位需要再次手术，第3例因脊髓空洞扩大需要早期再次手术。没有分流器堵塞或感染的病例。
脊髓空洞-蛛网膜下腔分流术是治疗特发性脊髓空洞症以及不适合或对其他治疗无反应的患者的一种安全有效的方法。
