J Korean Neurosurg Soc.  2015 Apr;57(4):311-313. 10.3340/jkns.2015.57.4.311.

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

• Akakin A
• Yilmaz B
• Eksi MS
• Kilic T

• KMID: 1956434
• DOI: http://doi.org/10.3340/jkns.2015.57.4.311

Abstract

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.

Keyword

Syringomyelia; Chiari malformation; Shunt; Decompression; Craniovertebral junction

MeSH Terms

Decompression
Encephalocele
Foramen Magnum
Humans
Syringomyelia*

Figure

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  Fig. 1 (A) Preoperative and (B) postoperative magnetic resonance imaging.

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  Fig. 2 First patient is in prone position and after C6-7 laminectomy, incision of dura and arachnoid membrane, we made a small dorsal myelotomy; while we inserted one arm of the T-tube into the syrinx, we placed the other arm in the subarachnoid space and tunneled distal part to the subcutaneous space at left flank region where the catheter was taken outside and carefully wrapped to provide the sterility. After positioning the patient in a lateral decubitus position, we rechanneled the catheter to the left para-umbilical area and inserted the distal part into the peritoneal cavity using the standard technique.

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