Frontiers in Surgery (Sep 2022)
Neurological deterioration after posterior fossa decompression for adult syringomyelia: Proposal for a summarized treatment algorithm
- Chenghua Yuan,
- Chenghua Yuan,
- Chenghua Yuan,
- Chenghua Yuan,
- Chenghua Yuan,
- Jian Guan,
- Jian Guan,
- Jian Guan,
- Jian Guan,
- Jian Guan,
- Yueqi Du,
- Yueqi Du,
- Yueqi Du,
- Yueqi Du,
- Yueqi Du,
- Zeyu Fang,
- Zeyu Fang,
- Zeyu Fang,
- Zeyu Fang,
- Zeyu Fang,
- Xinyu Wang,
- Xinyu Wang,
- Xinyu Wang,
- Xinyu Wang,
- Xinyu Wang,
- Qingyu Yao,
- Qingyu Yao,
- Qingyu Yao,
- Qingyu Yao,
- Qingyu Yao,
- Can Zhang,
- Can Zhang,
- Can Zhang,
- Can Zhang,
- Can Zhang,
- Zhenlei Liu,
- Zhenlei Liu,
- Zhenlei Liu,
- Zhenlei Liu,
- Zhenlei Liu,
- Kai Wang,
- Kai Wang,
- Kai Wang,
- Kai Wang,
- Kai Wang,
- Wanru Duan,
- Wanru Duan,
- Wanru Duan,
- Wanru Duan,
- Wanru Duan,
- Xingwen Wang,
- Xingwen Wang,
- Xingwen Wang,
- Xingwen Wang,
- Xingwen Wang,
- Zuowei Wang,
- Zuowei Wang,
- Zuowei Wang,
- Zuowei Wang,
- Zuowei Wang,
- Hao Wu,
- Hao Wu,
- Hao Wu,
- Hao Wu,
- Hao Wu,
- Fengzeng Jian,
- Fengzeng Jian,
- Fengzeng Jian,
- Fengzeng Jian,
- Fengzeng Jian
Affiliations
- Chenghua Yuan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Chenghua Yuan
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Chenghua Yuan
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Chenghua Yuan
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Chenghua Yuan
- National Center for Neurological Disorders, Beijing, China
- Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Jian Guan
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Jian Guan
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Jian Guan
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Jian Guan
- National Center for Neurological Disorders, Beijing, China
- Yueqi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Yueqi Du
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Yueqi Du
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Yueqi Du
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Yueqi Du
- National Center for Neurological Disorders, Beijing, China
- Zeyu Fang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Zeyu Fang
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Zeyu Fang
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Zeyu Fang
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Zeyu Fang
- National Center for Neurological Disorders, Beijing, China
- Xinyu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Xinyu Wang
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Xinyu Wang
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Xinyu Wang
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Xinyu Wang
- National Center for Neurological Disorders, Beijing, China
- Qingyu Yao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Qingyu Yao
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Qingyu Yao
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Qingyu Yao
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Qingyu Yao
- National Center for Neurological Disorders, Beijing, China
- Can Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Can Zhang
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Can Zhang
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Can Zhang
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Can Zhang
- National Center for Neurological Disorders, Beijing, China
- Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Zhenlei Liu
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Zhenlei Liu
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Zhenlei Liu
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Zhenlei Liu
- National Center for Neurological Disorders, Beijing, China
- Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Kai Wang
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Kai Wang
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Kai Wang
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Kai Wang
- National Center for Neurological Disorders, Beijing, China
- Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Wanru Duan
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Wanru Duan
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Wanru Duan
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Wanru Duan
- National Center for Neurological Disorders, Beijing, China
- Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Xingwen Wang
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Xingwen Wang
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Xingwen Wang
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Xingwen Wang
- National Center for Neurological Disorders, Beijing, China
- Zuowei Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Zuowei Wang
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Zuowei Wang
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Zuowei Wang
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Zuowei Wang
- National Center for Neurological Disorders, Beijing, China
- Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Hao Wu
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Hao Wu
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Hao Wu
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Hao Wu
- National Center for Neurological Disorders, Beijing, China
- Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
- Fengzeng Jian
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China,
- Fengzeng Jian
- Laboratory of Spinal Cord Injury and Functional Reconstruction, Xuanwu Hospital, Capital Medical University, Beijing, China
- Fengzeng Jian
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Fengzeng Jian
- National Center for Neurological Disorders, Beijing, China
- DOI
- https://doi.org/10.3389/fsurg.2022.968906
- Journal volume & issue
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Vol. 9
Abstract
BackgroundPatients with syringomyelia who present with new neurological symptoms after posterior fossa decompression (PFD) are not uncommon. However, systematic reports on different pathologies are few in the literature.ObjectiveThe purpose of this study was to summarize our experience for failed PFD.MethodsBetween January 2015 and December 2019, 85 consecutive failed PFD patients were identified. The neurological courses were summarized with Klekamp J (KJ) or mJOA score system for all patients. Long-term results were summarized with Kaplan-Meier method.ResultsTwenty-eight consecutive patients underwent FMDD (Foramen magnum and foramen of Magendie dredging) (Group I), extradural PFD and manipulation of tonsil was significantly associated with lower failure rates. Twenty patients underwent craniocervical fixation (Group II), nine underwent local spinal segment decompression (Group III), six underwent CSF diversion procedures, and one were treated for persistent pain by radiofrequency. Neuropathic pain was most significantly improved in Group I while swallowing improved in Group II within 1 year after the surgery. In the long term, late postoperative deterioration-free possibility in Group II was better than in Group I. All patients in Group III improved (P = 0.0088). Six cases of CSF diversion procedures were relieved in a short time. Pain in one patient persisted after PFD, and trial of radiofrequency failed.ConclusionNot only does the recurrent cerebrospinal fluid flow obstruct the foramen magnum, but also spinal pathologies and craniocervical instabilities may occur. This study provides the largest summarized clinical experience that may assist surgeons with different therapeutic decisions for failed PFD.
Keywords
