DOI QR코드

DOI QR Code

Treatment of Syringomyelia due to Chiari Type I Malformation with Syringo-Subarachnoid-Peritoneal Shunt

  • Akakin, Akin (Department of Neurosurgery, Bahcesehir University Medical School) ;
  • Yilmaz, Baran (Department of Neurosurgery, Bahcesehir University Medical School) ;
  • Eksi, Murat Sakir (Department of Orthopedics-Spine Center, University of California at San Francisco) ;
  • Kilic, Turker (Department of Neurosurgery, Bahcesehir University Medical School)
  • 투고 : 2014.06.17
  • 심사 : 2014.11.24
  • 발행 : 2015.04.28

초록

Chiari type I malformation is a tonsillar herniation more than 3 mm from the level of foramen magnum, with or without concurrent syringomyelia. Different surgical treatments have been developed for syringomyelia secondary to Chiari's malformations: craniovertebral decompression with or without plugging of the obex, syringo-subarachnoid, syringo-peritoneal, and theco-peritoneal shunt placement. Shunt placement procedures are useful for neurologically symptomatic large-sized syrinx. In this paper, authors define the first successful treatment of a patient with syringomyelia due to Chiari type I malformation using a pre-defined new technique of syringo-subarachnoid-peritoneal shunt with T-tube system.

키워드

참고문헌

  1. Ataizi S, Canakçi Z, Baloglu M, Cerezci A : Spontaneously resorbed idiopathic syringomyelia : a case report. Turk Neurosurg 17 : 247-250, 2007
  2. Bosmia AN, Tubbs RI, Clapp DC, Batzdorf U, Loukas M, Tubbs RS : Johann Conrad Brunner (1653-1727) and the first description of syringomyelia. Childs Nerv Syst 30 : 193-196, 2014 https://doi.org/10.1007/s00381-014-2358-y
  3. Chiari H : Ueber Veränderungen des Kleinhirns infolge von Hydrocephalie des Grosshirns. Dtsch Med Wochenschr 17 : 1172-1175, 1891 https://doi.org/10.1055/s-0029-1206803
  4. Depreitere B, Van Calenbergh F, van Loon J, Goffin J, Plets C : Posterior fossa decompression in syringomyelia associated with a Chiari malformation : a retrospective analysis of 22 patients. Clin Neurol Neurosurg 102 : 91-96, 2000 https://doi.org/10.1016/S0303-8467(00)00073-1
  5. Feldstein NA, Choudhri TF : Management of Chiari I malformations with holocord syringohydromyelia. Pediatr Neurosurg 31 : 143-149, 1999 https://doi.org/10.1159/000028850
  6. Gardner WJ, Goodall RJ : The surgical treatment of Arnold-Chiari malformation in adults; an explanation of its mechanism and importance of encephalography in diagnosis. J Neurosurg 7 : 199-206, 1950 https://doi.org/10.3171/jns.1950.7.3.0199
  7. Heiss JD, Suffredini G, Smith R, DeVroom HL, Patronas NJ, Butman JA, et al. : Pathophysiology of persistent syringomyelia after decompressive craniocervical surgery. Clinical article. J Neurosurg Spine 13 : 729-742, 2010 https://doi.org/10.3171/2010.6.SPINE10200
  8. Hida K, Iwasaki Y : Syringosubarachnoid shunt for syringomyelia associated with Chiari I malformation. Neurosurg Focus 11 : E7, 2001
  9. Hida K, Iwasaki Y, Koyanagi I, Sawamura Y, Abe H : Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery 37 : 673-678; discussion 678-679, 1995
  10. Iskandar BJ, Hedlund GL, Grabb PA, Oakes WJ : The resolution of syringohydromyelia without hindbrain herniation after posterior fossa decompression. J Neurosurg 89 : 212-216, 1998 https://doi.org/10.3171/jns.1998.89.2.0212
  11. Kim SH, Choi SW, Youm JY, Kwon HJ : Syringo-subarachnoid-peritoneal shunt using T-tube for treatment of post-traumatic syringomyelia. J Korean Neurosurg Soc 52 : 58-61, 2012 https://doi.org/10.3340/jkns.2012.52.1.58
  12. Klekamp J : Neurological deterioration after foramen magnum decompression for Chiari malformation type I : old or new pathology? J Neurosurg Pediatr 10 : 538-547, 2012 https://doi.org/10.3171/2012.9.PEDS12110
  13. Loukas M, Noordeh N, Shoja MM, Pugh J, Oakes WJ, Tubbs RS : Hans Chiari (1851-1916). Childs Nerv Syst 24 : 407-409, 2008 https://doi.org/10.1007/s00381-007-0535-y
  14. Markunas CA, Tubbs RS, Moftakhar R, Ashley-Koch AE, Gregory SG, Oakes WJ, et al. : Clinical, radiological, and genetic similarities between patients with Chiari Type I and Type 0 malformations. J Neurosurg Pediatr 9 : 372-378, 2012 https://doi.org/10.3171/2011.12.PEDS11113
  15. Milhorat TH, Miller JI, Johnson WD, Adler DE, Heger IM : Anatomical basis of syringomyelia occurring with hindbrain lesions. Neurosurgery 32 : 748-754; discussion 754, 1993 https://doi.org/10.1227/00006123-199305000-00008
  16. Naftel RP, Tubbs RS, Menendez JY, Wellons JC 3rd, Pollack IF, Oakes WJ : Worsening or development of syringomyelia following Chiari I decompression : case report. J Neurosurg Pediatr 12 : 351-356, 2013 https://doi.org/10.3171/2013.7.PEDS12522
  17. Navarro R, Olavarria G, Seshadri R, Gonzales-Portillo G, McLone DG, Tomita T : Surgical results of posterior fossa decompression for patients with Chiari I malformation. Childs Nerv Syst 20 : 349-356, 2004 https://doi.org/10.1007/s00381-003-0883-1
  18. Oldfield EH, Muraszko K, Shawker TH, Patronas NJ : Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 80 : 3-15, 1994 https://doi.org/10.3171/jns.1994.80.1.0003
  19. Tubbs RS, Webb DB, Oakes WJ : Persistent syringomyelia following pediatric Chiari I decompression : radiological and surgical findings. J Neurosurg 100 (5 Suppl Pediatrics) : 460-464, 2004
  20. Van den Bergh R : Pathogenesis and treatment of delayed post-traumatic syringomyelia. Acta Neurochir (Wien) 110 : 82-86, 1991 https://doi.org/10.1007/BF01402052
  21. Wetjen NM, Heiss JD, Oldfield EH : Time course of syringomyelia resolution following decompression of Chiari malformation Type I. J Neurosurg Pediatr 1 : 118-123, 2008 https://doi.org/10.3171/PED/2008/1/2/118
  22. Williams B : On the pathogenesis of syringomyelia : a review. J R Soc Med 73 : 798-806, 1980 https://doi.org/10.1177/014107688007301109
  23. Zhang ZQ, Chen YQ, Chen YA, Wu X, Wang YB, Li XG : Chiari I malformation associated with syringomyelia : a retrospective study of 316 surgically treated patients. Spinal Cord 46 : 358-363, 2008 https://doi.org/10.1038/sj.sc.3102141