Clinical effect of syringopleural shunt of patients with simple syringomyelia / 中国综合临床

Objective To evaluate the clinical effect of the simple syringomyelia patients with syringopleural shunt (SPS) and syringosubarachnoid shunt (SSS).Methods Twenty-eight patients with syringomyelia were selected as our subjects.Of which,18 patients were operated with SPS and 10 cases were with SSS.The therapy effect was compared between groups.Results All patients were checked with MRI 3 months after the operations and showed that syrinx cavity was significantly narrow of all patients.At early stage (48 h) after surgery 9 cases in SPS and 4 cases in SSS were showed the decrease syrinx cavity.Among patients with SPS,15 cases (83.3％) had the symptoms and signs improved,1 case (5.5％) withno changes,1 case (5.5％) with worse effect,and 1 cases(5.5％) occurred the tethered spinal cord.Meanwhile,among,patients with SSS,8 cases(80.0％) had the symptoms and signs improved,1 case(10.0％) with no changes,and 1 case (10.0％) with worse effect.There were 4 patients with pneumothorax in SPS group after operations,and the lung compression ratios were less than 5％.These cases were not taken any special treatment for the pneumothorax.All patients in two groups had not been infected and pleural effusions.No cases had taken the tube plugging.Conclusion The simple syringomyelia patients with the spine injury should take the cavity shunt.The SPS has some advantages because it can provide the partly negative pressure.But it should be certified by more cases and a long-time follow up.

Observation between Clinical Outcomes and the Size of the Syrinx with Magnetic Resonance Image

OBJECTIVE: This study was conducted to examine the correlation between clinical outcomes and the size of the syrinx in post-operative magnetic resonance imaging(MRI) and symptom duration. METHODS: The authors investigated twelve patients who underwent various operations for syringomyelia from January 1995 to December 2003. The authors retrospectively analyzed medical records, pre- and post-operative MRI findings, features and durations of symptoms, and the method of surgical treatments. The clinical outcomes were assessed on Prolo scale at 6 months of post-operative period. RESULTS: Neurologic symptoms did not promptly disappear after the shrinkage of syrinx, but post-operative MRI demonstrated most patients showed reductions in the size of the syrinx. There is no statistical relationship between clinical improvements and decrements of the syrinx size. However, patients who underwent surgical treatment within 2 years from the symptom onset had more favorable outcome than those who had operations after 2 years from the onset of symptoms. CONCLUSION: Change in the size of the syrinx in post-operative MRI is not directly proportional to favorable clinical outcomes. However, symptom duration before surgical treatment has considerable impact on the clinical outcomes.

Analysis on Surgical Outcome of Arnold-Chiari Malformation with Syringomyelia

The surgical outcomes of Arnold-Chiari malformation associated with syringomyelia have been reported with respect to improvement in symptoms and signs. But there are only a few studies about the changes of size in syrinx cavity after the era of magnetic resonance image. The authors employed two different surgical modalities and compared the difference in outcomes. Between 1988 and 1994, 17 patients suffering from Arnold-Chiari malformation associated with syringomyelia were treated by foramen magnum decompression(FMD), with or without shunt. Their ages ranged from 3 to 62 (median, 42) years; four were males and 13 were females. Eight were treated by FMD with syringosubarachnoid shunt (FMD with shunt group) and 9 by FMD only(FMD group). Changes in the extent of syrinx and clinical improvements were retrospectively compared between the two groups; the median follow-up period was 22(range 5-79) months. Changes in the extent of syrinx were analyzed by pre- and postoperative magnetic resonance images; improvements in symptoms or signs were classified by lower cranial nerves, the cerebellum and the spinal cord. The size of syrinx was decreased in 7/8 patients of FMD with shunt group(88%) and in 7/9 patients of FMD group (78%) and there was no significant difference in ratio statistically(p=0.54). Shrinkage of syrinx cavity was occurred regardless of its preoperative extent. In FMD with shunt group, 5/8 patients(63%) were improved in symptoms or signs and in FMD group, 6/9 patients(67%)(p=0.21). In all 3 cases which showed no collapse of syrinx cavity, the clinical improvements were not found. There was correlation between collapse of syringomyelia and improvement of clinical findings(p=0.035).

Surgical Treatment of Syringomyelia Secondary to Tuberculous Meningitis: Report of 4 Cases

The authors report our recent experience with 4 cases of syringomyelia that had developed secondary to tuberculous meningitis. Three cases of syringomyelia were treated by syringoperitoneal shunt and 1 case, by syringosubarachnoid shunt. Postoperatively, upper and lower extremity pain that had persisted in all the patients was relieved in all the patients, but improvement in limb sensation was noted in only 1 case. Improvement in limb motor power was noted in 3 cases. The clinical presentation, surgical consideration, and pathogenesis of syringomyelia is discussed together with a review of the literature.