Syringopleural shunt as a rescue procedure in patients with syringomyelia refractory to restoration of cerebrospinal fluid flow.

OBJECTIVE: Syringomyelia should be treated by reconstruction of the subarachnoid space and restoration of cerebrospinal fluid homeostasis. Direct intervention on the syrinx is a difficult choice and should be considered a rescue procedure. Data in the literature examining the various options are scanty, with generally unsatisfying results. We report our experience with shunting of the syrinx into the pleural space.

METHODS: Twenty patients with syringomyelia refractory to cerebrospinal fluid flow restoration underwent a procedure for placement of a syringopleural shunt between 1998 and 2008. Modified Japanese Orthopaedic Association Scale scores and magnetic resonance imaging were available for each patient preoperatively and at the latest follow-up evaluation. A 2-tailed Wilcoxon signed-rank test was used for statistical analysis. Complications related to the operative procedure and to hardware failure were noted.

RESULTS: Nineteen patients were available for follow-up with a mean duration of 37.5 (standard deviation, 31.1) months. The condition of 1 patient deteriorated, 2 remained stable, and the remainder improved. The overall mean improvement on the Modified Japanese Orthopaedic Association Scale was 19.5% (95% confidence interval, 8.5-30.5). The median improvement was 4 points on the 17-point scale. Results were statistically significant (P < 0.001). Follow-up magnetic resonance imaging showed syrinx collapse in 17 cases and marked shrinkage in 2 cases. Except for 1 case of meningitis followed by fatal pulmonary embolism, no significant complications were noted.

CONCLUSION: A syringopleural shunt should, in our view, be the syrinx diversion procedure of choice. More series of institutional experiences with a homogeneous approach would be helpful to verify this recommendation.