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Treatment of selected syringomyelias with syringo-pleural shunt: the experience with a consecutive 26 cases.
Clin Neurol Neurosurg. 2015 Oct; 137:50-6.CN

Abstract

OF BACKGROUND DATA

It is well established that syringomyelia can cause neurological symptoms and deficit by accumulation of fluid within syrinx cavities that lead to internal compression within the spinal cord. When other intervention treating the underlying etiology failed to yield any improvement, the next option would be a procedure to divert the fluid from the syrinx cavity, such as syringo-subarachnoid, syringo-peritoneal or syringo-pleural shunting. The indications and long term efficacy of these direct shunting procedures are still questionable and controversial.

OBJECTIVE

To investigate the clinical indication, outcome and complication of syringe-pleural shunt (SPS) as an alternative for treatment of syringomyelia.

STUDY DESIGN

We reported a retrospective 26 cases of syringomyelia were found to have indication for a diversion procedure. SPS was offered. Patients' symptoms, mJOA score, and MRI were collected to evaluate the change of the syringomyelia and prognosis of the patients. 2-tailed wilcoxon signed-rank test was used to perform the statistical analysis of the mJOA scores.

METHODS

All 26 patients underwent SPS. The clinical information was collected, the mean follow-up time was 27.4 months, 2-tailed wilcoxon signed-rank test was used to perform the statistical analysis of the mJOA scores. The key surgical technique, outcome and complications of SPS were reported in detail.

RESULTS

No mortality and severe complications occurred. Postoperative MRIs revealed near-complete resolution of syrinx in 14 patients, significant shrinkage of syrinx in 10 patients, no obvious reduction or unchanged in remaining 2 patient. Postoperatively, the symptoms improved in 24 cases (92.3%). Statistical analysis of the mJOA scores showed a statistical significance (P<0.001) between the preoperative group and the 2-week postoperative group. No further significant improvement between 2 weeks to the final follow up at 27 months.

CONCLUSION

Collapse or remarkable shrinkage of the syrinx by SPS could ameliorate or at least stabilize the symptoms for the patient. We recommend small laminectomy and a less than 3mm myelotomy either at PML or DREZ. The SPS procedure can be an effective and relatively long-lived treatment for the idiopathic syringomyelia and those that failed other options.

Authors+Show Affiliations

Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China. Electronic address: fan971@126.com.Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.Capital Medical University, Beijing, China.Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.Department of Neurological Surgery, Orthopedics and Sports Medicine, University of Washington, WA, United States.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26143129

Citation

Fan, Tao, et al. "Treatment of Selected Syringomyelias With Syringo-pleural Shunt: the Experience With a Consecutive 26 Cases." Clinical Neurology and Neurosurgery, vol. 137, 2015, pp. 50-6.
Fan T, Zhao X, Zhao H, et al. Treatment of selected syringomyelias with syringo-pleural shunt: the experience with a consecutive 26 cases. Clin Neurol Neurosurg. 2015;137:50-6.
Fan, T., Zhao, X., Zhao, H., Liang, C., Wang, Y., Gai, Q., & Zhang, F. (2015). Treatment of selected syringomyelias with syringo-pleural shunt: the experience with a consecutive 26 cases. Clinical Neurology and Neurosurgery, 137, 50-6. https://doi.org/10.1016/j.clineuro.2015.06.012
Fan T, et al. Treatment of Selected Syringomyelias With Syringo-pleural Shunt: the Experience With a Consecutive 26 Cases. Clin Neurol Neurosurg. 2015;137:50-6. PubMed PMID: 26143129.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of selected syringomyelias with syringo-pleural shunt: the experience with a consecutive 26 cases. AU - Fan,Tao, AU - Zhao,XinGang, AU - Zhao,HaiJun, AU - Liang,Cong, AU - Wang,YinQian, AU - Gai,QiFei, AU - Zhang,Fangyi, Y1 - 2015/06/22/ PY - 2015/03/04/received PY - 2015/06/09/revised PY - 2015/06/13/accepted PY - 2015/7/6/entrez PY - 2015/7/6/pubmed PY - 2016/8/31/medline KW - CSF homeostasis KW - Cerebrospinal fluid homeostasis KW - Myelotomy KW - Syringomyelia KW - Syringopleural shunting SP - 50 EP - 6 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 137 N2 - OF BACKGROUND DATA: It is well established that syringomyelia can cause neurological symptoms and deficit by accumulation of fluid within syrinx cavities that lead to internal compression within the spinal cord. When other intervention treating the underlying etiology failed to yield any improvement, the next option would be a procedure to divert the fluid from the syrinx cavity, such as syringo-subarachnoid, syringo-peritoneal or syringo-pleural shunting. The indications and long term efficacy of these direct shunting procedures are still questionable and controversial. OBJECTIVE: To investigate the clinical indication, outcome and complication of syringe-pleural shunt (SPS) as an alternative for treatment of syringomyelia. STUDY DESIGN: We reported a retrospective 26 cases of syringomyelia were found to have indication for a diversion procedure. SPS was offered. Patients' symptoms, mJOA score, and MRI were collected to evaluate the change of the syringomyelia and prognosis of the patients. 2-tailed wilcoxon signed-rank test was used to perform the statistical analysis of the mJOA scores. METHODS: All 26 patients underwent SPS. The clinical information was collected, the mean follow-up time was 27.4 months, 2-tailed wilcoxon signed-rank test was used to perform the statistical analysis of the mJOA scores. The key surgical technique, outcome and complications of SPS were reported in detail. RESULTS: No mortality and severe complications occurred. Postoperative MRIs revealed near-complete resolution of syrinx in 14 patients, significant shrinkage of syrinx in 10 patients, no obvious reduction or unchanged in remaining 2 patient. Postoperatively, the symptoms improved in 24 cases (92.3%). Statistical analysis of the mJOA scores showed a statistical significance (P<0.001) between the preoperative group and the 2-week postoperative group. No further significant improvement between 2 weeks to the final follow up at 27 months. CONCLUSION: Collapse or remarkable shrinkage of the syrinx by SPS could ameliorate or at least stabilize the symptoms for the patient. We recommend small laminectomy and a less than 3mm myelotomy either at PML or DREZ. The SPS procedure can be an effective and relatively long-lived treatment for the idiopathic syringomyelia and those that failed other options. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/26143129/Treatment_of_selected_syringomyelias_with_syringo_pleural_shunt:_the_experience_with_a_consecutive_26_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(15)00235-8 DB - PRIME DP - Unbound Medicine ER -