J Korean Neurosurg Soc.  2012 Jul;52(1):58-61. 10.3340/jkns.2012.52.1.58.

Syringo-Subarachnoid-Peritoneal Shunt Using T-Tube for Treatment of Post-Traumatic Syringomyelia

• Kim SH
• Choi SW
• Youm JY
• Kwon HJ

• KMID: 2190526
• DOI: http://doi.org/10.3340/jkns.2012.52.1.58

Abstract

Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures.

Keyword

Syringomyelia; Spinal cord injury; Shunt

MeSH Terms

Arm
Catheters
Humans
Laminectomy
Magnetic Resonance Spectroscopy
Middle Aged
Peritoneal Cavity
Proprioception
Spinal Cord Injuries
Spine
Subarachnoid Space
Syringomyelia

Figure

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  Fig. 1 Magnetic resonance images of the cervical (A) and thoracic spine (B) reveal the presence of a huge syrinx extending from the medulla to the L1 level.

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  Fig. 2 Schematic diagram showing the technique of syringo-subarachnoid-peritoneal shunt. The T-tube arms which have many side holes, are cut to the desired length and one arm is inserted into the syrinx (rostral direction), the other arm into subarachnoid space (caudal direction). CSF: cerebrospinal fluid.

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  Fig. 3 Postoperative magnetic resonance images of cervical (A) and thoracic (B) at 27 months after the surgery show considerable reduction in the size of the syringomyelic cavity.

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