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.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Pinna G, Alessandrini F, Alfieri A, Rossi M, Bricolo A. Cerebrospinal fluid flow dynamics study in Chiari I malformation: implications for syrinx formation. Neurosurg Focus. 2000;8:E3.
Guyotat J, Bret P, Jouanneau E, Ricci AC, Lapras C. Syringomyelia associated with type I Chiari malformation. A 21-year retrospective study on 75 cases treated by foramen magnum decompression with a special emphasis on the value of tonsils resection. Acta Neurochir (Wien). 1998;140:745–54.
Hida K, Iwasaki Y. Syringosubarachnoid shunt for syringomyelia associated with Chiari I malformation. Neurosurg Focus. 2001;11:E7.
Iwasaki Y, Hida K, Koyanagi I, Abe H. Reevaluation of syringosubarachnoid shunt for syringomyelia with Chiari malformation. Neurosurgery. 2000;46:407–12. Discussion 412-403.
Lesoin F, Petit H, Thomas CE 3rd, Viaud C, Baleriaux D, Jomin M. Use of the syringoperitoneal shunt in the treatment of syringomyelia. Surg Neurol. 1986;25:131–6.
Milhorat TH, Johnson WD, Miller JI. Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of upper cervical theca. J Neurosurg. 1992;77:871–4.
Padovani R, Cavallo M, Gaist G. Surgical treatment of syringomyelia: favorable results with syringosubarachnoid shunting. Surg Neurol. 1989;32:173–80.
Rhoton AL Jr. Microsurgery of Arnold–Chiari malformation in adults with and without hydromyelia. J Neurosurg. 1976;45:473–83.
Tator CH, Meguro K, Rowed DW. Favorable results with syringosubarachnoid shunts for treatment of syringomyelia. J Neurosurg. 1982;56:517–23.
Vassilouthis J, Papandreou A, Anagnostaras S, Pappas J. Thecoperitoneal shunt for syringomyelia: report of three cases. Neurosurgery. 1993;33:324–7. Discussion 327-328.
Williams B, Page N. Surgical treatment of syringomyelia with syringopleural shunting. Br J Neurosurg. 1987;1:63–80.
Isu T, Sasaki H, Takamura H, Kobayashi N. Foramen magnum decompression with removal of the outer layer of the dura as treatment for syringomyelia occurring with Chiari I malformation. Neurosurgery. 1993;33:845–9. Discussion 849-850.
Gambardella G, Caruso G, Caffo M, Germano A, La Rosa G, Tomasello F. Transverse microincisions of the outer layer of the dura mater combined with foramen magnum decompression as treatment for syringomyelia with Chiari I malformation. Acta Neurochir (Wien). 1998;140:134–9.
Kotil K, Ton T, Tari R, Savas Y. Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study. Cerebrospinal Fluid Res. 2009;6:7.
Sahuquillo J, Rubio E, Poca MA, Rovira A, Rodriguez-Baeza A, Cervera C. Posterior fossa reconstruction: a surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex—preliminary results and magnetic resonance imaging quantitative assessment of hindbrain migration. Neurosurgery. 1994;35:874–84. Discussion 884-875.
Alzate JC, Kothbauer KF, Jallo GI, Epstein FJ. Treatment of Chiari I malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus. 2001;11:E3.
Hida K, Iwasaki Y, Koyanagi I, Sawamura Y, Abe H. Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery. 1995;37:673–8. Discussion 678-679.
Hayhurst C, Richards O, Zaki H, Findlay G, Pigott TJ. Hindbrain decompression for Chiari–syringomyelia complex: an outcome analysis comparing surgical techniques. Br J Neurosurg. 2008;22:86–91.
Alfieri A, Pinna G. Long-term results after posterior fossa decompression in syringomyelia with adult Chiari type I malformation. J Neurosurg Spine. 2012;17:381–7.
Kalb S, Perez-Orribo L, Mahan M, Theodore N, Nakaji P, Bristol RE. Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation. J Clin Neurosci. 2012;19:1268–72.
Lee HS, Lee SH, Kim ES, Kim JS, Lee JI, Shin HJ, et al. Surgical results of arachnoid-preserving posterior fossa decompression for Chiari I malformation with associated syringomyelia. J Clin Neurosci. 2012;19:557–60.
Goel A, Desai K. Surgery for syringomyelia: an analysis based on 163 surgical cases. Acta Neurochir (Wien). 2000;142:293–301. Discussion 301-292.
Agarwal A, Thamburaj K. Syringosubarachnoid shunt for syringomyelia associated with Chiari I malformation. Pediatr Radiol. 2010;40(Suppl 1):S156.
Ergun R, Akdemir G, Gezici AR, Tezel K, Beskonakli E, Ergungor F, et al. Surgical management of syringomyelia–Chiari complex. Eur Spine J. 2000;9:553–7.
Benzel EC, Lancon J, Kesterson L, Hadden T. Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord. 1991;4:286–95.
Raffa G, Marseglia L, Gitto E, Germano A. Antibiotic-impregnated catheters reduce ventriculoperitoneal shunt infection rate in high-risk newborns and infants. Childs Nerv Syst. 2015;31:1129–38.
Raffa G, Conti A, Cardali SM, Angileri FF, Germano A. The efficacy of 90 cm–long peritoneal shunt catheters in newborns and infants. J Neurosurg Sci. 2017;61:33–8.
Batzdorf U. Chiari I malformation with syringomyelia. Evaluation of surgical therapy by magnetic resonance imaging. J Neurosurg. 1988;68:726–30.
Batzdorf U, Klekamp J, Johnson JP. A critical appraisal of syrinx cavity shunting procedures. J Neurosurg. 1998;89:382–8.
Sgouros S, Williams B. A critical appraisal of drainage in syringomyelia. J Neurosurg. 1995;82:1–10.
Vaquero J, Martinez R, Salazar J, Santos H. Syringosubarachnoid shunt for treatment of syringomyelia. Acta Neurochir (Wien). 1987;84:105–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
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. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-62515-7_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-62514-0
Online ISBN: 978-3-319-62515-7
eBook Packages: MedicineMedicine (R0)