Long Term Follow up of Syringo-subarachnoid Shunt Using Lumboperitoneal Shunt Tube in the Management of Non Communicating Syringomylia. Report of 10 Cases

Introduction: Our case series include 10 cases diagnosed with non communicating syringomyelia.
Inclusion criteria where symoptomatic syrinx not responding to medical treatment and no previous surgical intervention done.
Our series included 10 cases operated for syringo-subarachnoid shunts in Ain Shams University Hospitals and Arab Contractors medical center from year 2016.
All cases had a minimum follow up of at least 4 years, as our goal was to validate the long-term follow up of the technique.

Methods: Our series included 6 females and 4 males.
The presenting symptoms where pain in 70% of the cases (axial spinal pain of limb pains), redicular pain in 60% of the cases, and neurological deficits in 50% of the cases (spastic limb weakness and sphincteric affection.
7 cases had cervical +/_ thoracic syrinx and 3 cases isolated thoracic.
All cases where operated via midline posterior approach under image guidance to assess the level with single or multiple level laminectomies.

Results: In all cases we placed a regular lumbo-perotonal shunt tube in the most caudal part of the syrinx introduced microscopically through the dorsal root entry zone after dural incision.
In all cases we sutrued the tube with non absorbable stich to one limb of the dura before dural closure. The other side of the tube is left to go down in the subaracnoid space at least one level downwards.
The dura is sutured and the wound is closed in layers.
Temporary lost dorsal column sensations occurred in 3 out of 10 cases. Complete resolution with no treatment in a week.
Drain was left from 3-4 days until no CSF or blood was coming out of it and skin stich was taken at the puncture site.
All cases had postoperative CT scan on the day of the operation to ensure the shunt location.
Follow up MRI was done at 3 months then every 6 months afterwards.

Conclusion : No radiological recurrence.
Complete symptomatic relief in 50%, improvememt in 30%, stationary 20%