脊髓硬膜下腔分流術於頸部和胸部脊髓空洞症患者長期追蹤：病例報告

Syringosubarachnoid Shunt for Cervical and Thoracic Syringomyelia Associated with Type I Chiari Malformation: A Long-term Follow-up Case Report

脊髓空洞症被定義為脊髓內存在異常、充滿積液的腔隙，其病因多樣，如先天異常、外傷、腫瘤和不明原因。該病以多樣化的神經症狀呈現，讓診斷和治療充滿挑戰。本病例報告探討了頸部和胸部脊髓空洞症患者接受脊髓硬膜下腔分流術的長期效果。這是一名38歲女性的左上肢出現持續的癢感、輕觸覺喪失以及前臂和手指疼痛持續約一個月。神經學檢查符合頸髓病變，MRI顯示為I型Chiari畸形合併C3-T9脊髓空洞症。手術治療包括部分椎板切除術及脊髓硬膜下腔分流術，術後明顯改善症狀並減少脊髓空洞的大小。脊髓空洞症的治療首先應針對潛在原因，手術選擇包括直接解除蛛網膜沾黏以及多種分流術。本病例展示了脊髓硬膜下腔分流術在治療與Chiari畸形相關的頸部和胸部脊髓空洞症中的療效，長達13年的追蹤顯示神經學改善及脊髓空洞症穩定未復發。

 

Syringomyelia defined as the presence of abnormal, CSF-filled cavities in the spinal cord, presents with diverse etiologies, such as congenital anomalies, trauma, tumor and idiopathic origins. The diverse neurological conditions make the definitive diagnosis and optimal management challenging. This case report explores the long-term outcomes of syringosubarachnoid shunt in cervical and thoracic syringomyelia patient. A 38-year-old female presented persistent itchiness, decreased touch sensation, and left forearm/digits pain for one month. Neurological examinations indicated a cervical lesion, confirmed via MRI as Chiari I malformation with C3-T9 syringomyelia. Surgical intervention involved partial hemilaminectomy and syringosubarachnoid shunt, effectively relieving symptoms and reducing the syrinx size after operation. Syringomyelia treatments should be tailored toward the underlying mechanism whenever possible. Surgical options for treatment of symptomatic syringomyelia associated to Chiari I malformation include foramen magnum decompression with or without duraplasty and various shunting procedures. This case without receiving foramen magnum decompression demonstrates the efficacy of a syringosubarachnoid shunt in managing cervical and thoracic syringomyelia associated with Chiari malformation. Over 13 years of follow-up, stable syrinx size and sustained neurological improvement were observed.