Syringoperitoneal shunt in the treatment of syringomyelia

Background and purpose: A variety of methods have been employed for syrinx drainage, especially for treatment of syringomyelia unrelated to Chiari 1 malformation (C1M). Research on CSF circulation revealed that perpetual syrinx increase may result from disturbances of CSF flow and transient hypertension within the spinal subarachnoid space. Thus the concept of CSF drainage out of the spinal canal has arisen. The aim of the study is to present the outcome of patients with syringomyelia treated by placement of a syringoperitoneal shunt (SPS). Material and methods: An SPS was implanted in 5 patients with syringomyelia between 2004 and 2007. The syrinx was secondary to C1M in 2 patients, post-inflammatory in another 2 and idiopathic in 1 case. Myelotomy was performed over the widest part of the syrinx, at the lowest possible level. The proximal end of the drain was introduced into the syrinx rostrally, and the distal end to the peritoneum. For outcome evaluation late clinical and radiological results of treatment were used. The follow-up ranged from 1 to 4 years. Results: Clinical improvement or stabilization of symptoms was observed in 4 patients. One patient was re-operated on due to the drain slipping out of the syrinx. Despite syrinx decrease on follow-up MR scan, further clinical deterioration led to re-exploration of the cranio-cervical junction. Follow-up MR scans revealed syrinx decrease in all but 1 patient with C1M. Conclusions: Preliminary results suggest that SPS is a safe and efficient treatment method for patients with syringomyelia not related to structural anomalies at the cranio-vertebral junction. For treatment of syringomyelia secondary to C1M following failure of cranio-cervical decompression, another exploration of this area should be considered.