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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Long-term results 10-25 years after operations on 73 cases of posttraumatic syringomyelia

Langzeitergebnisse von 73 posttraumatischen Syringomyelien 10-25 Jahre nach OP

Meeting Abstract

  • corresponding author A. Aschoff - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • M. Stippich - Neuroradiologische Abteilung, Universitätsklinikum Heidelberg
  • M. Akbar - Orthopädische Abteilung, Universitätsklinikum Heidelberg
  • A. Unterberg - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • K. Geletneky - Neurochirurgische Klinik, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocSO.03.10

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Veröffentlicht: 30. Mai 2008

© 2008 Aschoff et al.
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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.