Artikel
Long-term results 10-25 years after operations on 73 cases of posttraumatic syringomyelia
Langzeitergebnisse von 73 posttraumatischen Syringomyelien 10-25 Jahre nach OP
Suche in Medline nach
Autoren
Veröffentlicht: | 30. Mai 2008 |
---|
Gliederung
Text
Objective: Posttraumatic syringomyelia (PTS) is a potential lifelong disease. There are numerous studies with a follow-up of 1-5 and some with up to 10 years, but only a few case reports and scattered data with long-term evaluations. Sgouros, Klekamp and others reported disappointing results after subarachnoid and extrathecal syrinx shunts. Therefore there is a special interest in compring these methods which were widely used in the 80ies with the more recently preferred strategies.
Methods: We found 73 patients with PTS ,who had undergone operative treatment between 1982 and 1997. 54 patients had operations exclusively in our department, 6 in external hospitals. 13 pretreated cases were reoperated by us. The most common procedures were 45 syringo-subarachnoid catheters (SSA), 38 as single revision-free procedure; 7 SSAs required revisions. We used microcatheters (>1.3 mm) exclusively, external surgeons usually larger tubes (2.0-3.5 mm). 2 had primary, 7 secondary decompressions (DC) and 4 SSA+DC, 3 received seconday shunts.
Results: 8/54 own patients achieved long-term full remission (14.8%), 21 (38.9%) had partial improvement and 19 (35.2%) a stabilization, combined 48 successful cases (88.9%). 6 cases deteriorated (11.1%). In all 73 patients including the external and combined cases, the cumulative success was found to be only 80.8%. Causes for poor results were mainly syrinx endoscopy (7/7 failures), arachnoiditis, iatrogenic tethered cord by dura-fixed or oversized catheters and traumatic op-techniques. In 45 SSAs there were 11.1% deteriorations, in cases of 9 decompression deterioration occurred in 22.2%; however, the last had a bias because of more complicated cases.
Conclusions: 1. PTS can be treated with long-term-success (incl. stabilization) in 81%, in a specialized department in 89%. 2. The negative SSA-experiences are true for historical op-techniques with oversized catheters etc., but not for microimplants. 3. The microcatheters may be less “causal”, but they are simpler, faster and less invasive than the time-consuming decompression and difficult arachnolysis resulting in comparable results. Both techniques have favorite indications: In presence of a traumatic 2-4-level-scar a SSA in the ascending thinwalled thoracal syrinx is superior, while cervical, multicystic, arachnitic subarachnoid spaces require decompressive duraplasties.