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Treatment of Holocord Syringomyelia-Chiari Complex by Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach.
Acta Neurochir Suppl. 2019; 125:133-138.AN

Abstract

BACKGROUND

Posterior fossa decompression with expansive duraplasty is the first-line surgical approach for the treatment of symptomatic syringomyelia associated with Chiari malformation. Despite good decompression, the clinical failure rate is reported to be up to 26%. A syringosubarachnoid (S-S) shunt may be used as a secondary option.

METHODS

In this paper we describe a single-institution experience of three cases of holocord syringomyelia-Chiari complex treated with foramen magnum decompression, expansive duraplasty and an S-S shunt carried out in a single-stage single approach. Following a standard suboccipital craniectomy, patients were submitted to syrinx fenestration and simultaneous insertion of an S-S shunt through a 1-mm posterior midline myelotomy at the C2 level prior to expansive dural reconstruction.

RESULTS

Postoperative imaging showed immediate reduction of the holocord cavities. Preoperative neurological deficits rapidly improved significantly and were stabilized at follow-up.

CONCLUSION

In our experience the positioning of the shunt catheter at a high level of the spinal cord (C2) did not add a significant risk of morbidity and obviated the need for a second operation and/or a separate incision in cases of clinical failure. This technique avoided the risk associated with a second surgery and its morbidity, and allowed prompt clinical recovery.

Authors+Show Affiliations

Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. giovanni.raffa@unime.it. Division of Neurosurgery, University of Messina, Messina, Italy. giovanni.raffa@unime.it.Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.Division of Neurosurgery, University of Messina, Messina, Italy.Division of Neurosurgery, University of Messina, Messina, Italy.Division of Neurosurgery, University of Messina, Messina, Italy.Division of Neurosurgery, University of Messina, Messina, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30610313

Citation

Raffa, Giovanni, et al. "Treatment of Holocord Syringomyelia-Chiari Complex By Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach." Acta Neurochirurgica. Supplement, vol. 125, 2019, pp. 133-138.
Raffa G, Priola SM, Abbritti RV, et al. Treatment of Holocord Syringomyelia-Chiari Complex by Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach. Acta Neurochir Suppl. 2019;125:133-138.
Raffa, G., Priola, S. M., Abbritti, R. V., Scibilia, A., Merlo, L., & Germanò, A. (2019). Treatment of Holocord Syringomyelia-Chiari Complex by Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach. Acta Neurochirurgica. Supplement, 125, 133-138. https://doi.org/10.1007/978-3-319-62515-7_19
Raffa G, et al. Treatment of Holocord Syringomyelia-Chiari Complex By Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach. Acta Neurochir Suppl. 2019;125:133-138. PubMed PMID: 30610313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of Holocord Syringomyelia-Chiari Complex by Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach. AU - Raffa,Giovanni, AU - Priola,Stefano Maria, AU - Abbritti,Rosaria Viola, AU - Scibilia,Antonino, AU - Merlo,Lucia, AU - Germanò,Antonino, PY - 2019/1/6/entrez PY - 2019/1/6/pubmed PY - 2019/8/23/medline KW - Chiari malformation KW - Holocord syringomyelia KW - Single-stage approach KW - Syringosubarachnoid shunt SP - 133 EP - 138 JF - Acta neurochirurgica. Supplement JO - Acta Neurochir Suppl VL - 125 N2 - BACKGROUND: Posterior fossa decompression with expansive duraplasty is the first-line surgical approach for the treatment of symptomatic syringomyelia associated with Chiari malformation. Despite good decompression, the clinical failure rate is reported to be up to 26%. A syringosubarachnoid (S-S) shunt may be used as a secondary option. METHODS: In this paper we describe a single-institution experience of three cases of holocord syringomyelia-Chiari complex treated with foramen magnum decompression, expansive duraplasty and an S-S shunt carried out in a single-stage single approach. Following a standard suboccipital craniectomy, patients were submitted to syrinx fenestration and simultaneous insertion of an S-S shunt through a 1-mm posterior midline myelotomy at the C2 level prior to expansive dural reconstruction. RESULTS: Postoperative imaging showed immediate reduction of the holocord cavities. Preoperative neurological deficits rapidly improved significantly and were stabilized at follow-up. CONCLUSION: In our experience the positioning of the shunt catheter at a high level of the spinal cord (C2) did not add a significant risk of morbidity and obviated the need for a second operation and/or a separate incision in cases of clinical failure. This technique avoided the risk associated with a second surgery and its morbidity, and allowed prompt clinical recovery. SN - 0065-1419 UR - https://www.unboundmedicine.com/medline/citation/30610313/Treatment_of_Holocord_Syringomyelia_Chiari_Complex_by_Posterior_Fossa_Decompression_and_a_Syringosubarachnoid_Shunt_in_a_Single_Stage_Single_Approach_ L2 - http://www.diseaseinfosearch.org/result/6981 DB - PRIME DP - Unbound Medicine ER -