MEAN TERM FOLLOW-UP OF A SERIES OF POSTTRAUMATIC SYRINGOMYELIA PATIENTS AFTER SYRINGO-PERITONEAL SHUNTING

We report the follow-up of a series of post-traumatic syringomyelia pa tients treated by syringo-peritoneal shunting (SPS). The neurological status was determined following the international ASIA/IMSOP standards for neurological classification of spinal cord injury; this was compl eted by a modified Silberstein classification that identifies the asce nding neurological symptoms as well as the increasing myelopathic symp toms in patients with post-traumatic syringomyelia. Magnetic resonance imaging (MRI) was systematically performed to assess the presence of a postoperative residual syrinx or of meningeal fibrosis. Eight patien ts were studied (five men, three women) with an age ranging from 17 to 54 years (mean of 30.7 years); at the time of the spinal cord injury. Three had a complete or nearly complete paraplegia, five were incompl ete. The post-traumatic syringomyelia was diagnosed from 2 to 8 years after the spinal cord injury and was treated by syringo-peritoneal shu nting. Early complications occurred in three patients: (1) displacemen t of the catheter, (2) obstruction of the catheter, and (3) haematomye lia, which disappeared after a new surgical procedure was performed. T he postoperative follow-up ranged from 3 to 9 years (mean of 4.5 years ). The neurological level decreased in every case and the ascending ne urological symptoms decreased or were stabilised in seven patients. Th e postoperative ASIA/IMSOP scores and the increasing myelopathic sympt oms improved in four patients but worsened in the four others, incompl ete. The MRI showed an important decrease of the syrinxes in every pat ient associated with a serious meningeal fibrosis in five cases. Syrin go-peritoneal shunting seems to be efficient in the treatment of the s yrinx but may have a poor effect regarding the prevention of meningeal fibrosis. The ascending neurological symptoms are more sensitive than the increasing myelopathic symptoms to syringo-peritoneal shunting es pecially in those with incomplete paraplegia.