Surgical treatment of posttraumatic syringomyelia

Abstract

Posttraumatic syringomyelia (PTS) is the main cause of delayed neurological deterioration after spinal cord injury. However, management principles of PTS have not been well established. We performed a retrospective study of 38 con­secu­tive patients with PTS (male : female = 31 : 7). Patients were divided into 2 groups: with complete (ASIA A, n=23) and incomplete spinal cord injury (ASIA B to E, n=15). All of 38 patients were surgically treated because of progressive neurological symptoms related with PTS. The prominent syringomyelia symptom was progressive upper limb sensory disturbance, but 6 out of 15 incomplete spinal cord injury patients presented with lower limb symptoms alone.

We performed 35 internal syrinx drainage surgeries (25 syrinx-subarachnoid shunts and 10 syringo-cisternal shunts) as initial treatment. Though in 8 patients syrinx re-expansion was observed, in 34 of 38 patients syrinx reduction was achieved as final result in the follow up period. Recurrence seen in 8 patients, was more frequent in cervical injury and rapid syrinx growth group. As an overall outcome in 38 patients, neurological improvement or stabilization after syrinx reduction was obtained in 33 patients (87%). Within this group, 17 patients (45%) improved neurologically with most remarkable recovery in the upper extremities motor function (15 of 17 patients). Despite of multiple shunt sur­geries, 5 patients (13%) neurologically deteriorated. In those cases untreated CSF blockage may have caused repeated spinal cord cavitation.

In conclusion, internal syrinx shunt technique provides favorable outcome for preventing neurological deterioration in posttraumatic syringomyelia patients especially in upper limb motor function. But shunt surgery may not improve intractable PTS patients in whom CSF circulation at spinal cord injury site still remains impaired.