A simple technique for thoracoscopic assisted placement of the distal limb of syringopleural shunts

Abstract

BackgroundSyringomyelia is an unusual accumulation of fluid within the spinal cord that may be associated with significant neurologic symptoms. Surgical drainage using various techniques is often required to reduce the intraparenchymal pressure and to alleviate symptoms. Syringopleural shunting seems to produce best results.Patients and methodsA simple technique to insert the distal limb of the syringopleural shunt into the pleural space is described in detail. The patient is placed in prone position. The syrinx is accessed from a dorsal incision and the proximal limb is inserted into the fluid cavity. The tube is tunneled through the subcutaneous space laterally and caudally. A 5mm blunt port is inserted lateral to the scapula and advanced under visual control using a 5mm 30° camera through the subcutaneous tissue and muscle and at the upper border of the 5th rib through the intercostals. With ventilation paused, the pleura is penetrated and CO2 is insufflated with a pressure of 8mm mercury. Under visual control the distal limb of the shunt is inserted at the pleural recessus and the tube is directed cranially. Positive airway pressure is applied re-expanding the lung. The trocar is removed from the pleural cavity and the skin is closed with subcuticular sutures.ResultsThe shunt was successfully placed in three consecutive cases including one redo case (1 male, 1 female aged 50 and 51 years with post traumatic syrinx). Postoperative chest x-ray excluded pneumothorax and no chest tube was required. Neurologic improvement was achieved in both patients.ConclusionsGeneral surgeons should be familiar with this simple technique similar to laparoscopic assisted placement of distal ventriculoperitoneal shunt catheters into the abdominal cavity.

Syringopleural Shunt Insertion Using a Minimally Invasive Approach: Technical Note, Case Series, and Review of the Literature

“…Two other studies were found in literature to date which utilised MIS approaches for the insertion of syringopleural shunts. A study by Bonatti and Kurtom [17] reported three cases (in two patients) of thoracoscopic assisted placement of the distal end of the catheter, which was generally well tolerated, with one patient showing immediate postoperative improvement, and the other showing cessation of disease progression after a redo procedure. Guest et al [18] reported seven cases of a percutaneous endoscopic approach for placement of the syringopleural or cystoperitoneal shunts.…”

“…Several reports have described MIS technique for insertion of syringosubarachnoid shunts [14][15][16], however reports on syringopleural shunts are scarce. Here, we report our experience for MIS insertion of syringopleural shunts, and discuss other reported experiences of MIS syringopleural shunting in literature [17,18].…”