gms | German Medical Science

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

22 posttraumatic syringobulbias in a series of 250 posttraumatic syringomyelias. Is a specific therapy necessary?

22 posttraumatische Syringobulbien unter 250 posttraumatischen Syringomyelien. Ist eine besondere Therapie erforderlich?

Meeting Abstract

  • corresponding author A. Aschoff - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • H. J. Gerner - Orthopädische Klinik, 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. DocMI.04.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc231.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Aschoff et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: 4.5-22% of all patients after serious spinal trauma develop a posttraumatic syringomyelia (PTS); about 10% ascend as syringobulbia (PTSB) into the medulla oblongata. Systematic investigations are rare, the therapy is controversial.

Methods: Since 1983 we collected 952 patients with syringomyelia. 250 (26.3%) of these had a PTS; 22 (8.8%) ascended into the brainstem (PTSB). The follow-up ranges max. 24 years; all were operated/assisted and controlled by one single investigator. In addition to the classical symptoms of spinal syringomyelia (dissociated sensory loss, distal palsies, pain), the PTSB-patients presented unilateral trigeminal sensory disturbances (18/22), rotatory nystagmus (15/22), disturbed functions of cranial nerves IX-XII and sleeping apnoe (6/22). The correclation between MRI-size and the clinical picture was not close. A few showed no brainstem symptoms, in other tiny lesions led to massive deficits. 20 PTSB-patients had 24 procedures (19 own, 5 external); most common were syringo-subarachnoid microcatheters (SSA) at thoracal levels (16), followed by decompressions of trauma (4) or craniocervical region (2). Including the cases of PTS, we have an overview of 248 operations in 137 patients, 171 own and 77 external. These consist of 102 SSAs, 70 decompressions / arachnolyses, 8 syringostomies, 23 shunts + revisions and 14 (external) endoscopies.

Results: Altogether 9 PTSB-patients improved, 7 were stabilized, and 4 deteriorated. The MRI-results were better: 18/20 PTSBs shrank. The results were similar to general PTS-operations, which showed full remission in 12%, improvement in 28.9%, stabilization in 44.6%. Altogether 83.1% were successful. 16.9% deteriorated, but only in one case was there a massive deterioration (quotes of own procedures).

Conclusions: We could not identify the causes or specific risk factors for syringobulbias. The distribution of trauma levels and the time lag between lesion and first new syrinx-related symptoms were similar to spinal PTS. - In contrast to many publications (probably with large catheters?) the micro-SSA showed better results than decompressions even long-term, but were biased by more uncomplicated patients. For uncomplicated syringobulbia we recommend syringo-subarachnoid microcatheters at thoracic level as the first choice. In case of arachnoiditic obstructions, multicystic syrinxes or PTSB and at high cervical levels, decompressive duraplasties and non-aggressive arachnolyses are to be preferred.