Long-term results and complications of the syringopleural shunting for treatment of syringomyelia: a clinical study.
BACKGROUND
The use of drains in the treatment of syringomyelia has a simple and immediate appeal. Syringopleural shunting in syringomyelia has produced good short-term results, but limited information is available on long-term effects. We analyzed the complications and long-term outcomes after syringopleural shunting for syringomyelia.


METHODS
Fourthy-four patients with large-sized syringomyelia underwent syringopleural shunting because of spinal cord compression between 1992 and 2010 in our clinic. Thirty-two patients had Chiari malformation type I (Group B), and 12 patients were associated with primary parenchymal cavitations (Group A). Their ages ranged from 14 to 71 years. Both craniovertebral decompression and syringopleural shunting were performed on 21 patients, whereas only syringopleural shunting was performed on another 21 patients.


RESULTS
The follow-up period ranged from 1 year to 17 years (mean: 9.1 years). There was no operative mortality. Early postoperative MRI revealed that syringes of 43 patients had collapsed. There were 9 (20.5%) minor complications in 9 patients, including temporary neurological deficits (6), respiratory distress (2) and headache (1). Seven (15.9%) serious complications [permanent neurological deficit (1), shunt migration (2), shunt misplacement (1), spinal instability (1), tethering (1), CSF over drainage (1)] were seen in five patients. Four of them were treated with a secondary operation. Three patients (3/9; 33.3%) who were treated by syringopleural shunt alone (Group B2) required craniovertebral decompression, although the shunt was functional. During long-term follow-up, three patients stabilized, five patients (11.3%) developed a worse neurological condition, and two of these patients died 10 and 7 years after surgery. Of all patients, 88.6% showed significant clinical improvement.


CONCLUSIONS
Although there were complications and failures, syringopleural shunting produced satisfactory results at long-term follow-up.
Department of Neurosurgery, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey. nejatisik@yahoo.com
Nejat
N
Isik
Ilhan
I
Elmaci
Nihal
N
Isik
S Ajlan
SA
Cerci
Recep
R
Basaran
Melek
M
Gura
Mufit
M
Kalelioglu
D000293:Adolescent; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013595:Syringomyelia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult