[A new operative technique of posttraumatic syringomyelia: thecoperitoneal shunt]

The authors report a successful case of operative treatment for a patient with a traumatic syringomyelia. A 33-year-old male presented with arm pain and right sided sensory loss due to posttraumatic syringomyelia. Magnetic resonance image showed syringomyelia from the upper cervical cord to the lower thoracic cord. Based on the hypothesis of Ball and Dayan, and Williams, a thecoperitoneal shunt operation was performed. The proximal shunt catheter was placed in the subarachnoid space rostral to the injury level and the distal shunt catheter was introduced percutaneously into the peritoneum. Postoperative radiological studies showed improvement and progressive clinical deterioration stopped. The advantages of this surgery are that it is less invasive to the spinal cord, and that there is a lower shunt malfunction rate because of the use of a D-L catheter which develops less shunt obstruction. Furthermore, we were able to evaluate shunt flow from the valve. In spite of multicystic syrinx, we were easily able to determine the placement of the shunt catheter for this operation. For these reasons, the thecoperitoneal shunt can be placed before further expansion of the syrinx. We think that this method is safer for patients with incomplete cord injury than S-P shunt or S-S shunt.