Thecal shunt placement for treatment of obstructive primary syringomyelia: Clinical article

Sandi Lam*, Ulrich Batzdorf, Marvin Bergsneider

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Object. The most commonly reported treatment of primary syringomyelia has been laminectomy with duraplasty or direct shunting from the syrinx cavity. Diversion of cerebrospinal fluid (CSF) from the spinal subarachnoid space to peritoneal, atrial, or pleural cavities has been described previously in only a few case reports. Shunting of the CSF from the subarachnoid space rostral to the level of myelographic blockage may reduce the filling force of the syrinx cavity and avoids myelotomy and manipulation of the spinal cord parenchyma. The authors report on 7 patients who underwent thecal shunt placement for primary spinal syringomyelia. Methods. This study is a retrospective review of a consecutive series. The authors reviewed the medical records and neuroimaging studies of 7 adult patients with posttraumatic, postsurgical, or postinflammatory syringomyelia treated with thecoperitoneal, thecopleural, or thecoatrial shunt placement at the University of California Los Angeles Medical Center. Myelographic evidence of partial or complete CSF flow obstruction was confirmed in the majority of patients. The mean duration of follow-up was 33 months (range 6-104 months). Results. Six (86%) of 7 patients showed signs of clinical improvement, whereas 1 remained with stable clinical symptoms. Of the 6 patients with available postoperative imaging, each demonstrated a reduction in syrinx size. Three patients (43%) had ≥ 1 complication, including shunt-induced cerebellar tonsillar descent in 1 patient and infections in 2. Conclusions. If laminectomy with duraplasty is not possible for the treatment of primary syringomyelia, placement of a thecoperitoneal shunt (or thecal shunt to another extrathecal cavity) should be considered. Although complications occurred in 3 of 7 patients, the complication rate was outweighed by a relatively high symptomatic and imaging improvement rate.

Original languageEnglish (US)
Pages (from-to)581-588
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume9
Issue number6
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

Keywords

  • Arachnoid scar
  • Syringomyelia syrinx
  • Thecal shunt
  • Thecoperitoneal shunt

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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