Treatment of Holocord Syringomyelia–Chiari Complex by Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach

  • Giovanni RaffaEmail author
  • Stefano Maria Priola
  • Rosaria Viola Abbritti
  • Antonino Scibilia
  • Lucia Merlo
  • Antonino Germanò
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)


Background: Posterior fossa decompression with expansive duraplasty is the first-line surgical approach for the treatment of symptomatic syringomyelia associated with Chiari malformation. Despite good decompression, the clinical failure rate is reported to be up to 26%. A syringosubarachnoid (S-S) shunt may be used as a secondary option.

Methods: In this paper we describe a single-institution experience of three cases of holocord syringomyelia–Chiari complex treated with foramen magnum decompression, expansive duraplasty and an S-S shunt carried out in a single-stage single approach. Following a standard suboccipital craniectomy, patients were submitted to syrinx fenestration and simultaneous insertion of an S-S shunt through a 1-mm posterior midline myelotomy at the C2 level prior to expansive dural reconstruction.

Results: Postoperative imaging showed immediate reduction of the holocord cavities. Preoperative neurological deficits rapidly improved significantly and were stabilized at follow-up.

Conclusion: In our experience the positioning of the shunt catheter at a high level of the spinal cord (C2) did not add a significant risk of morbidity and obviated the need for a second operation and/or a separate incision in cases of clinical failure. This technique avoided the risk associated with a second surgery and its morbidity, and allowed prompt clinical recovery.


Chiari malformation Holocord syringomyelia Single-stage approach Syringosubarachnoid shunt 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Giovanni Raffa
    • 1
    • 2
    Email author
  • Stefano Maria Priola
    • 3
  • Rosaria Viola Abbritti
    • 2
  • Antonino Scibilia
    • 2
  • Lucia Merlo
    • 2
  • Antonino Germanò
    • 2
  1. 1.Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
  2. 2.Division of NeurosurgeryUniversity of MessinaMessinaItaly
  3. 3.Division of NeurosurgeryUniversity of TorontoTorontoCanada

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