gms | German Medical Science

Objective: Since 1983 the MRI has solved most of the diagnostic problems of syringomyelia-Chiari and led to a steep increase of published operations

Methods: Since 1970 we collected 1,070 patients with syringomyelia and Chiari. Except for tumorous cases the most were operated by the first author. Of these, 32.7% had a foraminal syringomyelia/Chiari, each 26.0% an idiopathic / posttraumatic syrinx; 7.9% were postarachnoiditic, 5.5% tumor-associated and 1.9% vascular-malformative. We carried out 455 operations in 360 patients; including secondarily referred cases we overview 660 procedures in 423 patients. We used preferably decompressive duraplasties and syringo-subarachnoid micro-shunts. Follow-up: 1 month to 40 years.

Results: The best results showed Chiari-patients and patients with posttraumatic syringomyelia (success >90% vs. 80%). Idiopathic cases were less successful, arachnoiditic patients often presented with problems. Four patients died pre- and 2 postoperatively (not OP-related). The decompressive duraplasty showed good results in Chiari patients. In 50% the arachnoid could be preserved; tonsillar resection was not necessary. Surprisingly decompressions in other syrinx-types led relatively often to retethering and recurrences. In thoracic posttraumatic syringomyelias syringo-subarachnoid microcatheters are more simple and have comparable long-term results. After 13 (external) endoscopic and 1 LASER-procedures 11 patients acquired new neurodeficits in part with wheelchair-dependency (2) or serious new pain (3).

Conclusions: In foraminal cases the decompression is the first choice, and only details of the procedure remain controversial. Our good long-term-experiences with microcatheters in posttraumatic syringomyelia are in contrast to published results, which have been disappointing usually because of the use of large standard catheters. In our opinion there is more evidence for a multi- than for a monocausal hydrodynamic etiology.