COMPARISON OF SYRINGOPLEURAL AND SYRINGOSUBARACHNOID SHUNTING IN THE TREATMENT OF SYRINGOMYELIA IN CHILDREN

Case records from the Montreal Children's Hospital containing the diag nosis of shunted syringomyelia were retrospectively reviewed. From 198 4 to 1994, 31 patients had their syrinx treated by either syringopleur al (19 cases, Group A) or syringosubarachnoid (13 cases, Group B) shun ting. One patient was included in both groups. Associated diagnoses in cluded: in Group A, two cases of Chiari I and 14 of Chiari II malforma tions, 14 cases of shunted hydrocephalus, 13 cases of spina bifida ape rta, and three cases of spina bifida occulta; Group B, four cases of C hiari I and two of Chiari II malformations. four cases of shunted hydr ocephalus, two cases of spina bifida aperta, and five cases of spina b ifida occulta. Eight Group A and six Group B patients had undergone pr ior posterior fossa decompression. Motor deficits predominated in both groups and arachnoiditis was a uniform operative finding. Neurologica l follow-up examinations showed 11 Group A patients improved and eight stabilized, whereas on magnetic resonance imaging, 12 cavities appear ed to have collapsed, five were markedly reduced, and one had increase d. One patient underwent reoperation for pleural effusions and one for shunt displacement. In Group B, one patient improved, eight stabilize d, three worsened neurologically, and one was lost to follow-up review . Radiologically, one cavity appeared to have collapsed, six were sign ificantly reduced, two were unchanged, and three had enlarged. The aut hors conclude that syringopleural shunting is a valuable option for co ntrolling syringomyelia in patients without Chiari malformation or in patients who have previously undergone a craniovertebral decompression or are otherwise asymptomatic from their Chiari malformation.