Surgical management of syringomyelia-Chiari complex

Great variety exists in the indications and techniques recommended for the surgical treatment of syringomyelia-Chiari complex. More recently, magnetic resonance (MR) imaging has increased the frequency of diagnosis of this pa thology and offered a unique opportunity to visualize cavities inside the s pinal cord as well as their relationship to the cranio-cervical junction. T his report presents 18 consecutive adult symptomatic syringomyelia patients with Chiari malformation who underwent foramen magnum decompression and sy ringosubarachnoid shunting. The principal indication for the surgery was si gnificant progressive neurological deterioration. All patients underwent pr eoperative and postoperative MRI scans and were studied clinically and radi ologically to assess the changes in the syrinx and their neurological pictu re after surgical intervention. All patients have been followed up for at l east 36 months. No operative mortality was encountered; 88.9% of the patien ts showed improvement of neurological deficits together with radiological i mprovement and 11.1% of them revealed collapse of the syrinx cavity but no change in neurological status. None of the patients showed further deterior ation of neurological function. The experience obtained from this study dem onstrates that foramen magnum decompression to free the cerebro-spinal flui d (CSF) pathways combined with a syringosubarachnoid shunt performed at the same operation succeeds in effectively decompressing the syrinx cavity, an d follow-up MR images reveal that this collapse is maintained. In view of t hese facts, we strongly recommend this technique, which seems to be the mos t rational surgical procedure in the treatment of syringomyelia-Chiari comp lex.