Post-Traumatic Syringomyelia

Carroll, Áine; Brackenridge, Paula

doi:10.1097/01.brs.0000162277.76012.0b

Cited by 54 publications

(11 citation statements)

References 19 publications

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“…All cohorts/samples were independent, and we could not identify any overlap of included individuals. Overall, the sample sizes of the clinical studies detected by literature search ranged from case series of three up to studies including 600 individuals [ 2 , 4 , 5 , 9 , 11 , 13 , 14 , 16 , 18 , 23 – 40 , 42 – 53 , 55 , 56 , 59 , 60 , 62 ]. Observational designs were applied in all studies.…”

Section: Resultsmentioning

confidence: 99%

“… 62% cervical; 30% thoracic; 8% lumbar 100% surgery—40% arachnoid lysis, 38% syringo-subarachnoid drain, 20% arachnoid lysis+drain, and 2% arachnoid lysis, subsequent drain 23 months 33% improved, 15—60% stable, 27; 7% deteriorated, 3; 93% MRI improved, 42 16% complication—7% shunt failure, 2% CSF leak, and 7% neurological deficit (transient) Untethering can reduce cyst size and alleviate symptoms in the majority; duraplasty may be more physiological Schaan [ 46 ]; observational; N = 30 42 months 20% incomplete; 80% complete 33% cervical; 67% thoracic 100% surgery—(A) drain; (B) arachnoid lysis+drain+duraplasty—73% syringo-subarachnoid drain, 13% syringo-peritoneal drain, and 3% syringo-pleural drain; and (C) arachnoid lysis+duraplasty (A) 80 months; (B) 52 months; and (C) 46 months 50% improved; 33% stable; 14% deteriorated; 3% dead 1 death caused by pneumonia (3%) No significant difference for pain, motor deficit, sensory deficit between surgical procedures Lee [ 36 ]; observational; N = 3 n.a. 100% incomplete 66% thoracic; 33% holocord 100% surgery—33% arachnoid lysis+duraplasty and 67% arachnoid lysis+syringo-subarachnoid drain 14 months 66% improved; 33% stable No complication Restoration of CSF flow by decompression more effective than syrinx drain Carroll [ 11 ]; observational; N = 15 70 months 50% incomplete; 50% complete 31% cervical; 56% thoracic; 7% lumbar 6% conservative ( N = 1); 94% surgery ( N = 14)—47% syringo, peritoneal drain, 32% syringostomy+syringo-peritoneal drain, 7% arachnoid lysis, and 7% duraplasty n.a. Conservative—100% stable; surgery—31% improved, 25% stable, 19% deteriorated, 13% unavailable, and 6% dead 6% dead 1 Surgery has a positive effect on symptom progression, although no recommendation on optimal intervention Jaksche [ 28 ]; observational; N = 58 n.a.…”

Section: Resultsmentioning

confidence: 99%

“…Without a surgical treatment—i.e., following a “conservative” treatment—2% of patients improved and 88% remained stable, while 10% of patients deteriorated (total N = 198; Table 2 ) [ 4 , 5 , 11 , 14 , 25 , 32 – 34 , 40 , 45 , 46 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

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Treatment of posttraumatic syringomyelia: evidence from a systematic review

Kleindienst

Laut

Roeckelein³

et al. 2020

Acta Neurochir

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Background Following spinal cord injury (SCI), the routine use of magnetic resonance imaging (MRI) resulted in an incremental diagnosis of posttraumatic syringomyelia (PTS). However, facing four decades of preferred surgical treatment of PTS, no clear consensus on the recommended treatment exists. We review the literature on PTS regarding therapeutic strategies, outcomes, and complications. Methods We performed a systematic bibliographic search on (“spinal cord injuries” [Mesh] AND “syringomyelia” [Mesh]). English language literature published between 1980 and 2020 was gathered, and case reports and articles examining syrinx due to other causes were excluded. The type of study, interval injury to symptoms, severity and level of injury, therapeutic procedure, duration of follow-up, complications, and outcome were recorded. Results Forty-three observational studies including 1803 individuals met the eligibility criteria. The time interval from SCI to the diagnosis of PTS varied between 42 and 264 months. Eighty-nine percent of patients were treated surgically (n = 1605) with a complication rate of 26%. Symptoms improved in 43% of patients postoperatively and in 2% treated conservatively. Stable disease was documented in 50% of patients postoperatively and in 88% treated conservatively. The percentage of deterioration was similar (surgery 16%, 0.8% dead; conservative 10%). Detailed analysis of surgical outcome with regard to symptoms revealed that pain, motor, and sensory function could be improved in 43 to 55% of patients while motor function deteriorated in around 25%. The preferred methods of surgery were arachnoid lysis (48%) and syrinx drainage (31%). Conclusion Even diagnosing PTS early in its evolution with MRI, to date, no satisfactory standard treatment exists, and the present literature review shows similar outcomes, regardless of the treatment modality. Therefore, PTS remains a neurosurgical challenge. Additional research is required using appropriate study designs for improving treatment options.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Treatment of posttraumatic syringomyelia: evidence from a systematic review

Kleindienst

Laut

Roeckelein³

et al. 2020

Acta Neurochir

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“…This can occur in the setting of Chiari malformation and a similar mechanism may occur with trauma [ 5 ]. Trauma alone has been well described as a cause for syrinx formation [ 7 , 8 , 9 , 10 , 11 , 12 ]. In the unique case of our patient described here however, the situation is more complex.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Post-Traumatic Headache Complicated by Intracranial Hypotension

et al. 2016

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We present a case of post-traumatic headache complicated by intracranial hypotension resulting in an acquired Chiari malformation and myelopathy with syringomyelia. This constellation of findings suggest a possible series of events that started with a traumatic cerebral spinal fluid (CSF) leak, followed by descent of the cerebellar tonsils and disruption of CSF circulation that caused spinal cord swelling and syrinx. This unusual presentation of post-traumatic headache highlights the varying presentations and the potential sequelae of intracranial hypotension. In addition, the delayed onset of upper motor neuron symptoms along with initially normal head computerized tomography scan (CT) findings, beg the question of whether or not a post-traumatic headache warrants earlier magnetic resonance imaging (MRI).

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“… 9) PTS generally develops within 5 years after the initial spinal injury, but ranges from 6 months to 25 years. 2) …”

Section: Introductionmentioning

confidence: 99%

Clinical Features of Post-Traumatic Syringomyelia

Kim

et al. 2014

Korean J Neurotrauma

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ObjectiveThe purpose of this study was to analyze the clinical manifestations, radiological findings, treatment results, and clinical significance of post-traumatic syringomyelia (PTS).MethodsWe retrospectively reviewed the medical charts of nine surgical patients with symptomatic PTS between 1992 and 2012.ResultsThe most common clinical manifestation was development of new motor weakness. The mean interval between the initial injury and the onset of new symptoms 21.9 years. The mean length of the syringes observed on preoperative magnetic resonance images was 7.8 spinal levels. Shunting procedures were performed in five patients. Four patients underwent arachnoidolysis and duraplasty. Patients developed mechanical shunt failure. Postoperatively, one patient showed clinical improvement, four patients were stable, and four patients showed deterioration.ConclusionPTS is a disabling sequelae of spinal cord injury, which develops months to years after spinal injury. We have to consider that patients with PTS may have poor long-term outcome.

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Post-Traumatic Syringomyelia

Cited by 54 publications

References 19 publications

Treatment of posttraumatic syringomyelia: evidence from a systematic review

Treatment of posttraumatic syringomyelia: evidence from a systematic review

An Unusual Case of Post-Traumatic Headache Complicated by Intracranial Hypotension

Clinical Features of Post-Traumatic Syringomyelia

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