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Reevaluation of syringosubarachnoid shunt for syringomyelia with Chiari malformation.
Neurosurgery. 2000 Feb; 46(2):407-12; discussion 412-3.N

Abstract

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of syringosubarachnoid (S-S) shunting for syringomyelia with Chiari malformation. The authors describe the technical methods of performing the S-S shunt and the clinical results, including shunt malfunction.

METHODS

Forty-nine patients underwent S-S shunting. These patients were divided into three groups according to differences in the surgical technique used. Group I patients underwent laminectomy plus midline myelotomy and had a shunt tube placed in the dorsal subarachnoid space. Group II patients underwent laminectomy plus dorsal root entry zone myelotomy and had a shunt tube placed in the dorsolateral subarachnoid space. Group III patients underwent hemilaminectomy plus dorsal root entry zone myelotomy and had a shunt tube placed in the ventrolateral subarachnoid space.

RESULTS

Clinical results were generally satisfactory, especially in terms of pain relief, in all three groups. However, 10 patients among Groups I and II required follow-up surgery because of shunt problems; no second surgery was necessary for any patient in Group III.

CONCLUSION

The S-S shunt was very effective in deflating the syrinx, and the clinical results were satisfactory. Therefore, even though foramen magnum decompression is a very effective treatment, S-S shunting should be reevaluated and not rejected; it should be considered as one of the major surgical options. To prevent the possibility of cord injury by myelotomy or shunt malfunction, the dorsal root entry zone should be selected as the myelotomy site, and the shunt tube should be inserted into the ventral subarachnoid space at the cervical level.

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Authors+Show Affiliations

Iwasaki Y
Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Hida K
No affiliation info available
Koyanagi I
No affiliation info available
Abe H
No affiliation info available

MeSH

AdolescentAdultArnold-Chiari MalformationCerebrospinal Fluid ShuntsChildChild, PreschoolEquipment FailureFemaleFollow-Up StudiesHumansLaminectomyMagnetic Resonance ImagingMaleMiddle AgedNeurologic ExaminationPostoperative ComplicationsReoperationSubarachnoid SpaceSyringomyeliaTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10690730

Citation

Iwasaki, Y, et al. "Reevaluation of Syringosubarachnoid Shunt for Syringomyelia With Chiari Malformation." Neurosurgery, vol. 46, no. 2, 2000, pp. 407-12; discussion 412-3.
Iwasaki Y, Hida K, Koyanagi I, et al. Reevaluation of syringosubarachnoid shunt for syringomyelia with Chiari malformation. Neurosurgery. 2000;46(2):407-12; discussion 412-3.
Iwasaki, Y., Hida, K., Koyanagi, I., & Abe, H. (2000). Reevaluation of syringosubarachnoid shunt for syringomyelia with Chiari malformation. Neurosurgery, 46(2), 407-12; discussion 412-3.
Iwasaki Y, et al. Reevaluation of Syringosubarachnoid Shunt for Syringomyelia With Chiari Malformation. Neurosurgery. 2000;46(2):407-12; discussion 412-3. PubMed PMID: 10690730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reevaluation of syringosubarachnoid shunt for syringomyelia with Chiari malformation. AU - Iwasaki,Y, AU - Hida,K, AU - Koyanagi,I, AU - Abe,H, PY - 2000/2/26/pubmed PY - 2000/3/25/medline PY - 2000/2/26/entrez SP - 407-12; discussion 412-3 JF - Neurosurgery JO - Neurosurgery VL - 46 IS - 2 N2 - OBJECTIVE: The purpose of this study was to evaluate the effectiveness of syringosubarachnoid (S-S) shunting for syringomyelia with Chiari malformation. The authors describe the technical methods of performing the S-S shunt and the clinical results, including shunt malfunction. METHODS: Forty-nine patients underwent S-S shunting. These patients were divided into three groups according to differences in the surgical technique used. Group I patients underwent laminectomy plus midline myelotomy and had a shunt tube placed in the dorsal subarachnoid space. Group II patients underwent laminectomy plus dorsal root entry zone myelotomy and had a shunt tube placed in the dorsolateral subarachnoid space. Group III patients underwent hemilaminectomy plus dorsal root entry zone myelotomy and had a shunt tube placed in the ventrolateral subarachnoid space. RESULTS: Clinical results were generally satisfactory, especially in terms of pain relief, in all three groups. However, 10 patients among Groups I and II required follow-up surgery because of shunt problems; no second surgery was necessary for any patient in Group III. CONCLUSION: The S-S shunt was very effective in deflating the syrinx, and the clinical results were satisfactory. Therefore, even though foramen magnum decompression is a very effective treatment, S-S shunting should be reevaluated and not rejected; it should be considered as one of the major surgical options. To prevent the possibility of cord injury by myelotomy or shunt malfunction, the dorsal root entry zone should be selected as the myelotomy site, and the shunt tube should be inserted into the ventral subarachnoid space at the cervical level. SN - 0148-396X UR - https://www.unboundmedicine.com/medline/citation/10690730/Reevaluation_of_syringosubarachnoid_shunt_for_syringomyelia_with_Chiari_malformation_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1097/00006123-200002000-00026 DB - PRIME DP - Unbound Medicine ER -