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Syringo-Subarachnoid Shunt for the Treatment of Persistent Syringomyelia Following Decompression for Chiari Type I Malformation: Surgical Results.
World Neurosurg. 2017 Dec; 108:836-843.WN

Abstract

BACKGROUND

Approximately 30% of patients treated with foramen magnum decompression (FMD) for Chiari I-associated syringomyelia will show persistence, recurrence, or progression of the syrinx.

OBJECTIVE

This study evaluates the clinical and radiologic outcomes of syringo-subarachnoid shunt (SSS) as the treatment for persistent syringomyelia after FMD.

METHODS

Data were collected retrospectively. The primary outcome measurement was neurologic function (assessed with the Modified Japanese Orthopedic Association [mJOA] scale). Secondary outcome measurements were surgical complications, reoperation rate, and syrinx status on magnetic resonance imaging (MRI).

RESULTS

Twenty-one patients (14 females [66.7%]) underwent SSS, either concurrent to the FMD or at a later stage. Two minor surgical complications were seen: a wound dehiscence and postoperative kyphosis, both requiring revision surgery. No major complication or mortality occurred. The median change in the mJOA score was an improvement of 3 out of a possible 17 points on the scale (mean follow-up, 24.9 months). Expressed as a percentage, overall improvement was 11.8% (95% confidence interval [CI], 5.9-17.6; P < 0.001). On postoperative MRI, shrinkage of the syrinx was seen in all but 1 patient in whom the syrinx remained unchanged. Expressed as percentage, the improvement of the syrinx surface was 76.3% (95% CI, 65.0-87.7; P < 0.001), and the improvement of syrinx span was 36.4% (95% CI, 21.8-50.9; P = 0.05).

CONCLUSION

SSS for persistent, recurrent, or increasing syrinx following FMD for Chiari I malformation is a safe and effective surgical treatment when performed selectively by an experienced neurosurgeon.

Authors+Show Affiliations

Departments of Neurosurgery and Pediatric Neurosurgery, Sourasky Medical Center and Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel.Departments of Neurosurgery and Pediatric Neurosurgery, Sourasky Medical Center and Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel.Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.Departments of Neurosurgery and Pediatric Neurosurgery, Sourasky Medical Center and Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel.Departments of Neurosurgery and Pediatric Neurosurgery, Sourasky Medical Center and Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel.Departments of Neurosurgery and Pediatric Neurosurgery, Sourasky Medical Center and Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel. Electronic address: sconsts@netvision.co.il.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28807779

Citation

Soleman, Jehuda, et al. "Syringo-Subarachnoid Shunt for the Treatment of Persistent Syringomyelia Following Decompression for Chiari Type I Malformation: Surgical Results." World Neurosurgery, vol. 108, 2017, pp. 836-843.
Soleman J, Roth J, Bartoli A, et al. Syringo-Subarachnoid Shunt for the Treatment of Persistent Syringomyelia Following Decompression for Chiari Type I Malformation: Surgical Results. World Neurosurg. 2017;108:836-843.
Soleman, J., Roth, J., Bartoli, A., Rosenthal, D., Korn, A., & Constantini, S. (2017). Syringo-Subarachnoid Shunt for the Treatment of Persistent Syringomyelia Following Decompression for Chiari Type I Malformation: Surgical Results. World Neurosurgery, 108, 836-843. https://doi.org/10.1016/j.wneu.2017.08.002
Soleman J, et al. Syringo-Subarachnoid Shunt for the Treatment of Persistent Syringomyelia Following Decompression for Chiari Type I Malformation: Surgical Results. World Neurosurg. 2017;108:836-843. PubMed PMID: 28807779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Syringo-Subarachnoid Shunt for the Treatment of Persistent Syringomyelia Following Decompression for Chiari Type I Malformation: Surgical Results. AU - Soleman,Jehuda, AU - Roth,Jonathan, AU - Bartoli,Andrea, AU - Rosenthal,Daniel, AU - Korn,Akiva, AU - Constantini,Shlomi, Y1 - 2017/08/12/ PY - 2017/04/30/received PY - 2017/07/29/revised PY - 2017/08/01/accepted PY - 2017/8/16/pubmed PY - 2017/12/27/medline PY - 2017/8/16/entrez KW - Chiari I malformation KW - Electrophysiologic monitoring KW - Foramen magnum decompression KW - Posterior columns KW - Spinal cord KW - Syringo-subarachnoid shunt KW - Syringomyelia SP - 836 EP - 843 JF - World neurosurgery JO - World Neurosurg VL - 108 N2 - BACKGROUND: Approximately 30% of patients treated with foramen magnum decompression (FMD) for Chiari I-associated syringomyelia will show persistence, recurrence, or progression of the syrinx. OBJECTIVE: This study evaluates the clinical and radiologic outcomes of syringo-subarachnoid shunt (SSS) as the treatment for persistent syringomyelia after FMD. METHODS: Data were collected retrospectively. The primary outcome measurement was neurologic function (assessed with the Modified Japanese Orthopedic Association [mJOA] scale). Secondary outcome measurements were surgical complications, reoperation rate, and syrinx status on magnetic resonance imaging (MRI). RESULTS: Twenty-one patients (14 females [66.7%]) underwent SSS, either concurrent to the FMD or at a later stage. Two minor surgical complications were seen: a wound dehiscence and postoperative kyphosis, both requiring revision surgery. No major complication or mortality occurred. The median change in the mJOA score was an improvement of 3 out of a possible 17 points on the scale (mean follow-up, 24.9 months). Expressed as a percentage, overall improvement was 11.8% (95% confidence interval [CI], 5.9-17.6; P < 0.001). On postoperative MRI, shrinkage of the syrinx was seen in all but 1 patient in whom the syrinx remained unchanged. Expressed as percentage, the improvement of the syrinx surface was 76.3% (95% CI, 65.0-87.7; P < 0.001), and the improvement of syrinx span was 36.4% (95% CI, 21.8-50.9; P = 0.05). CONCLUSION: SSS for persistent, recurrent, or increasing syrinx following FMD for Chiari I malformation is a safe and effective surgical treatment when performed selectively by an experienced neurosurgeon. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/28807779/Syringo_Subarachnoid_Shunt_for_the_Treatment_of_Persistent_Syringomyelia_Following_Decompression_for_Chiari_Type_I_Malformation:_Surgical_Results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)31299-8 DB - PRIME DP - Unbound Medicine ER -