Syringo-subarachnoid shunt: how I do it

Jehuda Soleman; Jonathan Roth; Shlomi Constantini

doi:10.1007/s00701-019-03810-x

Acta Neurochirurgica

February 2019, Volume 161, Issue 2, pp 367–370 | Cite as

Syringo-subarachnoid shunt: how I do it

Authors
Authors and affiliations

Jehuda Soleman
Jonathan Roth
Shlomi Constantini

How I Do it - Pediatric Neurosurgery

First Online: 22 January 2019

34 Downloads

Part of the following topical collections:

Pediatric Neurosurgery

Abstract

Background

Syringo-subarachnoid shunt (SSS) is a valid method for the treatment of syringomyelia persisting after foramen magnum decompression (FMD) for Chiari I malformation.

Method

We give a brief overview on indication and outcome of SSS, followed by a detailed description of the surgical anatomy, and of the microsurgical technique. In particular, we highlight some key points for complication avoidance.

Conclusion

SSS is a valid option to treat syringomyelia, since in experienced hands, the outcome is good in most patients, including those with holocord syringomyelia. Careful understanding of anatomy and spinal cord physiology is required to minimize complications.

Keywords

Syringo-subarachnoid shunt Syringomyelia Chiari I malformation Spinal cord Microsurgery Pediatric neurosurgery Spinal electrophysiological monitoring

This is a preview of subscription content, to check access.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Key points

- The main indication of SSS is persistent, progressing, recurrent, or newly developed syringomyelia after FMD decompression for Chiari I malformation.

- Before indicating SSS surgery, hydrocephalus, regrowth of the posterior fossa bone (especially in young children), scoliosis, tethered cord syndrome, spinal cord tumors, and spinal instability should be ruled out.

- Microsurgical technique, accompanied by neuromonitoring are imperative as they help preserve neurological function.

- The identification of the posterior midline (posterior median sulcus) of the SC is essential, in order to avoid damage to the ascending columns of the posterior SC.

- Small pial arteries fold medially towards the posterior median sulcus, aiding the surgeon in identifying the midline.

- The syrinx is best reached through a blunt dissection of the SC posterior midline using a plated bayonet, so that the surrounding neuronal structures are minimally affected.

- As an alternative, if the syringomyelia is bulging laterally, it can be approached through the DREZ.

- The shunt catheter is inserted 2–3 cm into the syrinx cavity and subarachnoid space rostrally and cranially, respectively.

- The shunt catheter has to be long enough (at least 4 cm) and must be sutured to the arachnoid, to lower the risk of shunt dislocation.

- The goal of surgery is to release pressure from the SC and prevent further neurological deterioration.

Supplementary material

ESM 1

Video showing the surgical technique of syringo-subarachnoid shunt insertion. (MP4 256145 kb)

References

1.
Epstein FJ, Ozek M (1993) The plated bayonet: a new instrument to facilitate surgery for intra-axial neoplasms of the spinal cord and brain stem. Technical note. J Neurosurg 78(3):505–507CrossRefGoogle Scholar
2.
Pencovich N, Korn A, Constantini S (2013) Intraoperative neurophysiologic monitoring during syringomyelia surgery: lessons from a series of 13 patients. Acta Neurochir 155(5):785–791 discussion 791CrossRefGoogle Scholar
3.
Sgouros S, Williams B (1995) A critical appraisal of drainage in syringomyelia. J Neurosurg 82(1):1–10CrossRefGoogle Scholar
4.
Soleman J, Roth J, Bartoli A, Rosenthal D, Korn A, Constantini S (2017) Syringo-subarachnoid shunt for the treatment of persistent syringomyelia following decompression for Chiari type I malformation: surgical results. World Neurosurg 108:836–843CrossRefGoogle Scholar

Copyright information

Authors and Affiliations

Jehuda Soleman
- 1
- 2
Email authorView author's OrcID profile
Jonathan Roth
- 1
Shlomi Constantini
- 1

1.Departments of Neurosurgery and Pediatric Neurosurgery, Tel Aviv Medical Center and Dana Children’s Hospital Tel AvivTel Aviv UniversityTel AvivIsrael
2.Department of Neurosurgery, Division of Pediatric NeurosurgeryUniversity Hospital and Children’s Hospital of BaselBaselSwitzerland

Syringo-subarachnoid shunt: how I do it

Abstract

Background

Method

Conclusion

Keywords

Notes

Compliance with ethical standards

Conflict of interest

Supplementary material

References

Copyright information

Authors and Affiliations

Personalised recommendations

Cite article