Surgical treatment of posttraumatic syringomyelia.
OBJECTIVE
The present study evaluates the effectiveness of 2 surgical procedures, shunting and untethering, for posttraumatic syringomyelia.


METHODS
We retrospectively reviewed the medical charts of all surgical patients with posttraumatic syringomyelia in our department. Shunting was performed before 1997; after 1997, we used arachnoidolysis and untethering.


RESULTS
Shunting was performed in 15 patients, and 19 patients underwent arachnoidolysis. Statistical analysis found that the 2 groups did not differ in age or initial clinical or radiological presentation. All patients suffered from progressively worsening symptoms. Reconstruction of the subarachnoid space by arachnoidolysis and untethering the cord allowed us to improve or stabilize 94% of our patients. Shunting exposed the patients to a higher rate of clinical recurrence and reoperation. Comparisons between the 2 groups found a significant difference (better results) in favor of arachnoidolysis for the McCormick classification (P = .03), American Spinal Injury Association motor score of the lower extremities (P = .02), and subjective grading (P = .001). There was no significant difference in the evolution of pain or the Vaquero index between the 2 groups; however, a tendency appeared in favor of arachnoidolysis for cyst evolution in regard to the extent of the cyst and the Vaquero index (P = .05).


CONCLUSIONS
Our results confirmed that arachnoidolysis is an effective and safe treatment for posttraumatic syringomyelia. Because the majority of patients were stabilized, we concluded that surgery should be performed as soon as possible in patients with clearly progressing clinical features.
Aghakhani
Nozar
N
Department of Neurosurgery, Bicetre University Hospital, Bicetre, France. Nozar.aghakhani@bct.aphp.fr
Baussart
Bertrand
B
David
Philippe
P
Lacroix
Catherine
C
Benoudiba
Farida
F
Tadie
Marc
M
Parker
Fabrice
F
D000293:Adolescent; D000328:Adult; D001099:Arachnoid / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D013346:Subarachnoid Space / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013595:Syringomyelia / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult