KISEP Clinical Article J Korean Neurosurg Soc , 2002 공동지주막하단락술을시행한척수공동증환자의임상분석 한석 김주한 임동준 조태형 박정율 박윤관 정흥섭 서중근 Evaluation of Syringo-Subarachno

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1 KISEP Clinical Article J Korean Neurosurg Soc , 2002 공동지주막하단락술을시행한척수공동증환자의임상분석 한석 김주한 임동준 조태형 박정율 박윤관 정흥섭 서중근 Evaluation of Syringo-Subarachnoid Shunt for Syringomyelia Seok Han, M.D., Joo Han Kim, M.D., Dong Jun Lim, M.D., Tai Hyung Cho, M.D., Jung Yul Park, M.D., Youn Kwan Park, M.D., Heung Seob Chung, M.D., Jung Keun Suh, M.D. Department of Neurosurgery, Korea University Medical School, Seoul, Korea ObjectiveThe aim of this study is to evaluate the effectiveness of the syringo-subarachnoid shunt for the syringomyelia, according to the clinical outcome and radiological changes. MethodsTen patients who underwent syringo-subarachnoid shunt during last 5 years were included in this analysis. The average age at the presentation was 32.6range 7 to 51 years. Chiari I malformation was found in four patients, Post-infectious syringomyelia was in three patients, and posttraumatic syringomyelia in two patients. The most common presenting symptoms were motor weakness and pain. Radiological diagnosis was made by magnetic resonance image in all patients. All patients underwent syringo-subarachnoid shunt, and in five patients with Chiari I malformation or achondroplasia, foramen magnum decompression was done as well. ResultsEight showed the significant clinical improvement. Remaining two patients showed stabilization of the symptom. The postoperative magnetic resonance image, performed in seven cases, showed the reduction of the syrinx size in all case. There was no shunt malfunction or infection in our series. The transient cerebospinal fluid leakage was noted in three cases. ConclusionIt appears that the syringo-subarachnoid shunt is beneficial surgical method for the syringomyelia of various etiologies. KEY WORDSSyringo-subarachnoid shuntsyringomyelia. 서론 - J Korean Neurosurg SocVolume 31January,

2 대상및방법 결 과 Table 1. Characteristics of ten patients Age/Sex Diagnosis Postoperative MRI Case 1 7/M Chiari I malformation Case 2 46/F Post-infectious Case 3 28/M Chiari I malformation Case 4 36/F Chiari I malformation Case 5 51/M Post-infectious Case 6 31/M Achondroplasia with syringomyelia Case 7 32/F Post-traumatic Case 8 39/F Chiari I malformation Case 9 29/M Post-infectious Case 10 27/M Post-traumatic Table 2. Clinical features at admission in ten patients Motor Sensory Pain DTR Long Tract Sign Case 1 Asymptomatic Intact Hyperactive None Case 2 Intact Hypesthesia Normoactive None Case 3 Weakness Intact Hyperactive Ankle clonus+ Case 4 Weakness Dissociative Hyperactive Ankle clonus+ Case 5 Weakness Dissociative Hyperactive Babinski+ Case 6 Weakness Hypesthesia Hyperactive None Case 7 Weakness Hypesthesia, dissociative Hyperactive Ankle clonus+ Case 8 Intact Intact Hyperactive Ankle clonus,hoffman+ Case 9 Weakness Hypesthesia Hyperactive Ankle clonus+ Case 10 Weakness Dissociative Hyperactive None Muscle atrophy was found in the case 3, 7, 9, 10 Muscle spasticity was seen in case5 22 J Korean Neurosurg SocVolume 31January, 2002

the upward reduction of the cerebellar tonsil and marked shrinkage of the syrinx. Table 3.

syringosubarachnoid shuntmidline,dorsal syringosubarachnoid shuntmidline,dorsal Syringosubarachnoid shuntmidline,dorsal syringosubarachnoid shuntdrez*,dorsal Syringosubarachnoid shuntdrez*,ventral

3 A B Fig. 1. T1-weighted Magnetic resonance image of cervical region preoperativelya and seven days after the syringo-subarachnoid shuntb in the patient with postinfectious syringomyelia showing the marked shrinkage of the syrinx. A B Fig. 2. Magnetic resonance image T1WI of the cervical region preoperativelya and 12 days after foramen magnum decom- with syringosubarachnoid shunt in the patient with pression Chiari malformation showing the upward reduction of the cerebellar tonsil and marked shrinkage of the syrinx. Table 3. Operative methods & complications Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 type of operation syringosubarachnoid shuntmidline,dorsal Syringosubarachnoid shuntmidline,dorsal syringosubarachnoid shuntmidline,dorsal syringosubarachnoid shuntmidline,dorsal Syringosubarachnoid shuntmidline,dorsal syringosubarachnoid shuntdrez*,dorsal Syringosubarachnoid shuntdrez*,ventral Case 8 syringosubarachnoid shuntdrez*,dorsal Case 9 Syringosubarachnoid shuntdrez*,ventral Case 10 Syringosubarachnoid shuntmidline,dorsal DREZdorsal root entry zone The transient CSF leakage was found in the case3, 4, 6 Table 4. Clinical & radiological results of ten cases Case 1 Stabilized Clinical results Case 2 Stabilized Case 3 Motor improvement 고 찰 Radiological results, tonsilar reduction, cisternal widening Motor, sensory Case 4 improvement Case 5 Spasticity improvement Case 6 Sensory improvement Motor, sensory Case 7 improvement Case 8 Pain improvement Case 9 Sensory improvement Case 10 Sensory improvement - -, tonsilar reduction J Korean Neurosurg SocVolume 31January,

4 J Korean Neurosurg SocVolume 31January, 2002

5 결 론 References 1. Aboulker JLa syringomyelie et les liquides intra-rachidiens. Neurochirurgie 25(suppl)1-144, Anton HA, Schweigel JFPosttraumatic syringomyeliathe British Columbia Experience. Spine , Backe HA, Betz RR, Mesgarzadeh M, Beck T, Clancy MPosttraumatic spinal cord cyst evaluated by magnetic resonance imaging. Paraplegia , Ball MJ, Dayan ADPathogenesis of syringomyelia. Lancet , Barbaro NM, Wilson CB, Gutin PH, Edward MBSurgical treatment of syringomyelia. J Neurosurg , Batzdorf U, Klekamp J, Johnson JPA critical appraisal of syrinx cavity shunting procedures. J Neurosurg , Gardner WJHydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry , Gardner WJ, Angel JThe mechanism of syringomyelia and its surgical correction. Clin Neurosurg , Heiss JD, Patronas N, Devroom HL, Shawker T, Ennis R, Kammerer W, et alelucidating the pathophysiology of syringomyelia. J Neurosurg , Hida K, Iwasaki Y, Imamura H, Abe HPosttraumatic syringomyelia : Its characteristic magnetic resonance imaging findings and surgical management. J Neurosurg , Isu T, Iwasaki Y, Akino M, Abe HSyringosubarachnoid shunt for syringomyelia associated with Chiari malformationtype. Acta Neurochir(Wien) , Iwasaki Y, Hida K, Koyanagi I, Abe HReevaluation of syringosubarachnoid shunt for syringomyelia with Chiari malformation. Neurosurgery , Lewy WJ, Mason L, Hahn JFChiari maformation presenting in adultsa surgical experience in 127 cases. Neurosurgery , Logue V, Edward MRSyringomyelia and its surgical treatment-an analysis of 75 patients. J Neurol Neurosurg Psychiatry , Love TG, Olafson RASyringomyeliaA look at surgical therapy. J Neurosurg , Matsumoto T, Symon LSurgical management of syringomyelia-current results. Surg Neurol , Nunomura M, Iwasaki K, Akino M, Abe H, Hida K, Saito H MRI of chronic spinal cord injury. Neurotraumatology(Tokyo) , Oldfield EH, Muraszko K, Shawker TH, Patronas NJPathophysiology of syringomyelia associated with Chiari I malformatio of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg , Ollivier CPTraite de la Moelle Epiniere et ses Maladies. Constenant I Histoire Anatomique, Physiologique et Pathologique de ce Centre Nerveux Chez I Homme, ed 2. ParisCrevot, 1827, Vol Padonavi R, Cavallo M, Gaist GSurgical treatment of syringomyeliafavorable results with syringosubarachnoid shunting. Surg Neurol , Park TS, Cail WS, Broaddus WC, Walker MGLumboperitoneal shunt combined with myelotomy for treatment of syringohydromyelia. J Neurosurg , Pitts FW, Groff RASyringomyeliacurrent status of surgical therapy. Surgery , Tator CH, Meguro K, Rowed DWFavorable results with syringosubarachnoid shunts for treatment of syringomyelia. J Neurosurg , Tator CH, Briceno CTreatment of syringomyelia with a syringosubarachnoid shunt. Can J Neurol Sci , Taylor ARAnother theory of the aetiology of the syringomyelic cavity. J Neurol Neurosurg Psychiatry 35825, 1975 abstract J Korean Neurosurg SocVolume 31January,

6 26. Ventureyra, Enrique CG,Tekkok Ismail HSyringotomy using myringotomy tubetechnical note. Neurosurgery , Vernet O, Farmer JP, Montes JLComparison of syringopleural and syringosubarachnoid shunting in the treatment of syringomyelia in children. J Neurosurg , Welch K, Shilito J, Strand R, Fisher EG, Winston KRChiari I malforamtin-an acquired disorder? J Neurosurg , Wetzel N, Davis LSurgical treatment of syringomyelia. Arch Surg , William B, Terry AF, Johnes HWF, McSweeney TSyringomyelia as a sequal to traumatic paraplegia. Paraplegia , J Korean Neurosurg SocVolume 31January, 2002

KISEP Clinical Article J Korean Neurosurg Soc , 2003 외상이나지주막염에의한척수공동증의수술적치료 장현동 박관호 지문표 김재오 김정철 Operative Treatments in Syringomyelia Caused

KISEP Clinical Article J Korean Neurosurg Soc 33264-270, 2003 외상이나지주막염에의한척수공동증의수술적치료 장현동 박관호 지문표 김재오 김정철 Operative Treatments in Syringomyelia Caused by Trauma or Arachnoiditis Hyeon Dong Jang, M.D., Kwan