title: Surgical treatment of idiopathic syringomyelia: Silastic wedge syringosubarachnoid shunting technique.
abstract: BACKGROUND
  The underlying pathophysiology leading to syringomyelia is elusive with multiple flow-related theories constituting our current limited understanding of the disease process. Syringomyelia is associated with pathologies related to the disturbance of cerebral spinal fluid flow found in conditions such as Chiari I malformations, spinal malignancy, spinal cord tethering, trauma, or arachnoid adhesions. Our aim is to describe a unique surgical shunting technique used to treat refractory cases of idiopathic syringomyelia.
  
  
  METHODS
  Five patients, aged 22-50, presented with progressive neurologic symptoms associated with an idiopathic syrinx. All underwent decompressive laminectomy surgery with syringosubarachnoid shunting using the silastic wedge technique.
  
  
  RESULTS
  In five cases of idiopathic syringomyelia, clinical and radiographic follow up ranges from 3 to 36 months. Three patients have radiographic and clinical follow up greater than 24 months. All patients improved clinically and their symptoms have been stable.
  
  
  CONCLUSIONS
  Shunting procedures for the syringomyelia disease spectrum have been criticized due to the inconsistent long-term outcomes. This surgical technique used to treat symptomatic idiopathic syringomyelia has been devised based on our intraoperative experience, surgical outcomes, and evaluation of the literature. The purpose of the wedges is to preserve patency of the communication between the syrinx cavity and the expanded subarachnoid space by preventing healing of the myelotomy edges and by maintaining an artificial conduit between the syrinx cavity and the subarachnoid space. Although short-term results are promising, continued long-term follow up is needed to determine the ultimate success of the silastic wedge shunting procedure.
authors.affiliation: Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA.
authors.forename: Teck M
authors.initials: TM
authors.lastname: Soo
authors.affiliation: Section of Neurosurgery, Department of Surgery, Providence Hospital and Medical Centers, Southfield and Novi, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Sandquist
authors.affiliation: Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA.
authors.forename: Doris
authors.initials: D
authors.lastname: Tong
authors.affiliation: Michigan Spine and Brain Surgeons, PLLC, Southfield, MI, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Barrett
keywords: Idiopathic syringomyelia; silastic wedge technique; syringosubarachnoid shunt
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