Syringomyelia-subarachnoid shunt

Syringomyelia is a slow-moving formation of the inner cavity of the spinal cord, which is more common in the neck section and less in the chest and lumbar segments. The void often continues for several segments, sometimes involving the medulla. Most of the holes are single and a few are multiple. The etiology of this disease can be divided into congenital and traumatic, tumor, inflammation and other secondary. Congenital people are often accompanied by cerebellar tonsil sputum type I or with a skull base. The mechanism of syringomyelia formation is not the same as that proposed by Willian (1975): when the occipital foramen obstruction, the intracranial pressure and spinal canal pressure difference increase, and the fourth ventricle cerebrospinal fluid ascends along the upper end of the central canal. Oldfield (1994) and Iskandar (1998) believe that the central canal of the spinal cord is not open, and is a cavity formed by the cerebrospinal fluid on the surface of the spinal cord entering the spinal cord along the perivascular space. Due to the degeneration of the spinal cord itself and the gradual enlargement of the syringomyelia, an oppressive effect on the spinal cord tissue occurs, and the corresponding spinal nerve bundle damage syndrome appears. Cervical syringomyelia has peripheral nerve spasm in this segment, upper limb weakness, hand and arm muscle atrophy and sensory separation disorder (ie, pain temperature loss or disappearance, and deep feeling exists). Symptoms of central long-term damage appear below the segment of spinal cord injury, resulting in the formation of incomplete paralysis of the limbs and more severe neurotrophic disorders. Treating diseases: syringomyelia Indication Spinal stenosis - subarachnoid shunt is applicable to: 1, primary and secondary syringomyelia, symptoms of spinal cord compression and nerve damage. 2. After decompression of the posterior fossa of the cervical medullary cavity, the cavity does not shrink or disappear, and the clinical symptoms of the patient are not improved. Contraindications Late syringomyelia, severe degeneration of the spinal cord caused by paraplegia, or limb contracture, is generally not suitable for surgery. Preoperative preparation 1. General preparation of the whole body According to the condition and examination, the patient's general condition is actively improved, and various necessary supplements and corrections are given. 2, those with constipation, pre-operative laxatives, enema during the night before surgery. Those with dysuria should be catheterized before surgery and indwelling catheter. 3, neck lesions affect the respiratory, preoperative should be deep breathing, cough and other training, a few days before surgery can start aerosol inhalation, if necessary, antibiotics. 4, postoperative need to prone, should be prone position training in advance, so that patients can adapt to this lying position. 5, sedatives before the operation, phenobarbital 0.1g. 6, fast within 6 ~ 8h before surgery. 7, the day before surgery to prepare the surgical skin, cleaning shaving, the range should be more than 15cm around the incision. Neck surgery should shave the occipital hair. 8. According to the needs of anesthesia, give medication before anesthesia. 9, preoperative positioning should be determined before the scheduled removal of the spine position of the lamina, the easiest way is to locate according to the body surface markers. Commonly used body surface markers are: 1 the posterior spine of the 1st posterior sacral spine is the 7th cervical spine; 2 arms naturally sag, the scapula slings are connected through the 3rd thoracic spinous process; 3 pairs The arm is naturally drooping, and the line connecting the lower scapula of the shoulder is passed through the 6th thoracic spinous process; 4 umbilical level is equivalent to the third lumbar spinous process; 5 is the highest point of the bilateral iliac crest, passing through the 4th lumbar spinous process; The posterior superior iliac spine line is equivalent to the second vertebral body. Due to the difference in body shape, there may be 1 or 2 spine errors in the positioning of the above markers. In order to avoid the error, it can be positioned according to the body surface marker, and then a type of lead is glued on the body surface of the corresponding spinous process. After taking the X-ray film, the surgical site is verified from the position of the lead on the X-ray film. Surgical procedure 1. Incision In the expected lesion site, the incision line was marked with gentian violet, and a straight incision was made on the spinous process. 2, laminectomy Laminectomy is performed in the lesion area, but the extent of the resection of the lamina depends on the location of the syringomyelia. 3, dural incision exploration The tension of the spinal capsule is increased, and the dura mater is pulled from the suture on both sides of the dural sac and cut from the midline. Care should be taken to avoid tearing the arachnoid, and the spinal cord of the syringomyelia segment can be seen through the arachnoid membrane. The color of the spinal cord is yellowish white and the blood vessels are sparse. 4, in the midline of the spinal cord or the most bulging place with a fine needle puncture, extracting a colorless or light yellow transparent liquid, can be confirmed as a cavity. The spinal cord was cut along the thinnest and avascular area near the posterior medial sulcus in the lower part of the syringomyelia, and the incision was about 5 mm long. The silicone ventricle drainage catheter was used to place the distal end exactly into the ventral or ventral subarachnoid space of the spinal trabeculae to reduce tube end occlusion. The proximal end is inserted into the cavity through the spinal incision, and the depth of the catheter is 2 to 3 cm, so that the liquid in the cavity is drained to the subarachnoid space of the spinal cord. A thin wire is sewn at the arachnoid incision to fix the catheter and a small piece of gelatin sponge is placed over it. 5. Strictly suture the dura mater, followed by suturing the muscle layer, subcutaneous tissue and skin. complication If the syringomyelia is too large or the high-necked spinal cord is damaged, the spinal cord tissue will collapse after decompression, which may aggravate the symptoms of the nervous system and even lead to respiratory failure.

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