Syrinx to subarachnoid shunting for syringomyelia

Objective: Surgery for syringomyelia generally aims to treat the underlying cause, if it is known. Optimal management is unclear for idiopathic syringomyelia, or where treatment of the putative cause has failed or is high risk. Syrinx to subarachnoid shunting is an option for these cases; a series is reported to assess the outcomes of this approach.

Methods: We retrospectively analysed the clinical and radiological features of a consecutive series of patients with syringomyelia treated with syrinx to subarachnoid shunting.

Results: Forty-one patients (19 male, 4-79 years old) were treated from 2000 to 2016, including 15 patients with idiopathic syringomyelia, 13 with spinal trauma, five with Chiari malformation, four with arachnoiditis, three with tethered cord, and one patient with arachnoid bands. Patients were treated with a syrinx to subarachnoid shunt, with a subset also undergoing expansile duraplasty. At follow-up (3-108 months, mean 36 months) syrinx size was reduced in 37 patients, and there was improvement or stabilization of symptoms in all but one patient. Three patients had temporary lower limb sensory symptoms after surgery. Other complications were two transient cerebrospinal fluid leaks, a pseudomeningocoele, and one post-operative myocardial infarction. Two cases of shunt dislodgement required re-operation and a third case required early re-operation for an enlarging syrinx. There were no cases of shunt blockage or infection.

Conclusions: Syrinx to subarachnoid shunting is a safe and effective treatment for idiopathic syringomyelia and for patients that are not suitable for, or have not responded to, other treatment.