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Syringopleural shunt for refractory syringomyelia: how I do it

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Abstract

Background

Surgical treatment of syringomyelia is directed at the reconstruction of the subarachnoid space and restoration normal cerebrospinal fluid flow. Direct intervention on the syrinx is a rescue procedure and should be offered to patients with refractory syringomyelia.

Methods

We provide an overview on indications and technique of syringopleural shunt (SPS). The procedure involves the connection of syrinx with the pleural space using a lumboperitoneal shunt. The occurrence of a negative pressure inside the pleural compartment offers an appropriate gradient for drainage from the syrinx.

Conclusions

The SPS allows for a safe and effective treatment of persistent syringomyelia when management of the underlying cause does not yield substantial improvement.

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Authors and Affiliations

  1. Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy

    Paolo Perrini, Nicola Benedetto, Alberto Vercelli & Davide Tiziano Di Carlo

  2. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy

    Paolo Perrini & Davide Tiziano Di Carlo

Authors
  1. Paolo Perrini
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  2. Nicola Benedetto
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  3. Alberto Vercelli
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  4. Davide Tiziano Di Carlo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Alberto Vercelli, Nicola Benedetto, and Davide Tiziano Di Carlo. The first draft of the manuscript was written by Paolo Perrini and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Paolo Perrini.

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Key points

1. SPS is indicated in refractory syringomyelia after failure of surgical procedures that address the underlying cause.

2. Syringomyelia persistence after foramen magnum decompression for CMI is the main indication for SPS.

3. The laminectomy site is centered at the widest and most caudal portion of the syrinx as demonstrated by the MRI.

4. Intraoperative neurophysiological monitoring with MEP and SSEPs is required to minimize postoperative neurological complications.

5. Myelotomy should not exceed 3 mm and is performed in an area with a paucity of blood vessels along the midline.

6. The holes of proximal tip catheter should line within syringomyelia cavity to avoid syrinx persistence and low-pressure headache.

7. The paramedian thoracic incision is performed below the tip of the scapula to avoid dislodgment of the catheter.

8. The distal end of the catheter should be shortened to the appropriate length to avoid pleuritic chest pain.

9. Postoperative pleural effusion is a common finding at the postoperative chest X-ray and is generally self-limiting.

10. Postoperative shrinkage of the syrinx is observed at follow-up MRI in the majority of patients.

Supplementary Information

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Supplementary file1 (MP4 426266 KB)

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Perrini, P., Benedetto, N., Vercelli, A. et al. Syringopleural shunt for refractory syringomyelia: how I do it. Acta Neurochir 165, 3039–3043 (2023). https://doi.org/10.1007/s00701-023-05654-y

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  • DOI: https://doi.org/10.1007/s00701-023-05654-y

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