Treatment of Holocord Syringomyelia-Chiari Complex by Posterior Fossa Decompression and a Syringosubarachnoid Shunt in a Single-Stage Single Approach

Posterior fossa decompression with expansive duraplasty is the first-line surgical approach for the treatment of symptomatic syringomyelia associated with Chiari malformation. Despite good decompression, the clinical failure rate is reported to be up to 26%. A syringosubarachnoid (S-S) shunt may be used as a secondary option.In this paper we describe a single-institution experience of three cases of holocord syringomyelia-Chiari complex treated with foramen magnum decompression, expansive duraplasty and an S-S shunt carried out in a single-stage single approach. Following a standard suboccipital craniectomy, patients were submitted to syrinx fenestration and simultaneous insertion of an S-S shunt through a 1-mm posterior midline myelotomy at the C2 level prior to expansive dural reconstruction.Postoperative imaging showed immediate reduction of the holocord cavities. Preoperative neurological deficits rapidly improved significantly and were stabilized at follow-up.In our experience the positioning of the shunt catheter at a high level of the spinal cord (C2) did not add a significant risk of morbidity and obviated the need for a second operation and/or a separate incision in cases of clinical failure. This technique avoided the risk associated with a second surgery and its morbidity, and allowed prompt clinical recovery.