TY - JOUR
T1 - Syringo-Subarachnoid Shunt for the Treatment of Persistent Syringomyelia Following Decompression for Chiari Type I Malformation
T2 - Surgical Results
AU - Soleman, Jehuda
AU - Roth, Jonathan
AU - Bartoli, Andrea
AU - Rosenthal, Daniel
AU - Korn, Akiva
AU - Constantini, Shlomi
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/12
Y1 - 2017/12
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.
AB - 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.
KW - Chiari I malformation
KW - Electrophysiologic monitoring
KW - Foramen magnum decompression
KW - Posterior columns
KW - Spinal cord
KW - Syringo-subarachnoid shunt
KW - Syringomyelia
UR - http://www.scopus.com/inward/record.url?scp=85028824251&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2017.08.002
DO - 10.1016/j.wneu.2017.08.002
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C2 - 28807779
AN - SCOPUS:85028824251
SN - 1878-8750
VL - 108
SP - 836
EP - 843
JO - World Neurosurgery
JF - World Neurosurgery
ER -