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Therapeutic lumbar puncture as a potential treatment for symptomatic paediatric syringomyelia: A single centre cohort
Anna Bjornson1, Edward Goacher2, Matthew Myers2
1Department of Neurosurgery, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK. abjornson@nhs.net.
Insights
Therapeutic lumbar puncture offers a safe and effective treatment for pediatric idiopathic syringomyelia. Higher opening pressure may predict better outcomes in patients with this spinal cord condition.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Medicine
Background:
- Idiopathic syringomyelia involves spinal cord syrinx formation without a clear cause.
- Patients often experience symptoms like back pain, leg pain, and neurological deficits.
Purpose of the Study:
- To evaluate the clinical and radiological outcomes of pediatric patients with idiopathic syringomyelia treated with therapeutic lumbar puncture.
- To identify factors influencing treatment success.
Main Methods:
- A retrospective review of pediatric patients with idiopathic syringomyelia who underwent lumbar puncture over 10 years.
- Data collected included pre- and post-procedural symptoms, neurological status, opening pressure, and drainage volume.
Main Results:
- 31 pediatric patients underwent therapeutic lumbar puncture.
- 23% showed significant long-term improvement, 42% had temporary improvement, and 10% resolved after multiple procedures.
- Symptomatic improvement was associated with higher opening pressure (≥24cmH2O). Complications included headache and back pain.
Conclusions:
- Therapeutic lumbar puncture is a potentially safe and effective treatment for pediatric idiopathic syringomyelia.
- Higher opening pressure is a predictor of successful outcomes in this patient group.
Purpose:
Idiopathic syringomyelia represents a group of patients with a syrinx without an underlying pathological cause. Patients may present with back pain, leg pain and/or neurological dysfunction. We aim to examine the clinico-radiological outcomes of paediatric patients presenting with idiopathic syringomyelia managed with a therapeutic lumbar puncture.
Methods:
All paediatric patients with idiopathic syringomyelia who underwent a lumbar puncture over a 10-year time period were identified and included. Pre- and post-procedural clinico-radiological features were obtained from electronic patient records. Procedural details, including opening pressure and drainage volume, were obtained from electronic operative records.
Results:
31 patients underwent a therapeutic lumbar puncture. Median age at time of first lumbar puncture was 12 years (range 2-17). 7/31 (23%) patients had significant long-term improvement or resolution in their symptoms following a single lumbar puncture. 13/31 (42%) patients had temporary improvement of their symptoms and underwent further lumbar punctures. 3/31 (10%) patients had resolution of their symptoms after more than one lumbar puncture. 8/31 (26%) patients did not experience any improvement in their symptoms. Symptomatic improvement was more likely in those with a high opening pressure of equal to or greater than 24cmH2O (OR 13 (1.3 - 126.3) P = 0.02). Median length of follow up was 3 yrs (range 6 months - 9 years). Complications occurred in 9/31 (29%) patients, with 8 of these experiencing a low pressure headache, and 1 patient experiencing temporary back pain following the lumbar puncture.
Conclusion:
Lumbar puncture may be a safe and effective treatment for symptomatic idiopathic syringomyelia in the paediatric population. It appears to be more effective in those with a higher opening pressure.
