title: Syringopleural shunt as a rescue procedure in patients with syringomyelia refractory to restoration of cerebrospinal fluid flow.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinica Neurochirurgica, c/o Centro Tramautologico Ortopedico, Firenze, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cacciola
authors.forename: Matteo
authors.initials: M
authors.lastname: Capozza
authors.forename: Paolo
authors.initials: P
authors.lastname: Perrini
authors.forename: Nicola
authors.initials: N
authors.lastname: Benedetto
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
mesh_terms: D000328:Adult; D000368:Aged; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013346:Subarachnoid Space / Q000601:surgery*; D013595:Syringomyelia / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome