CT-guided percutaneous drainage of syringomyelia

Purpose: Our purpose is to describe CT-guided percutaneous drainage of syringomyelia as a possible contribution in patient management. Method: CT-guided percutaneous drainage was performed on three patients with symptomatic syringomyelia. We determined the success of percutaneous decompression by subsequent CT and MRT. The effect of syringomyelia decompression in relation to the patient's symptoms was determined. This information was then used to help guide clinical management. Results: In Case 1, percutaneous drainage of a large syrinx in a C5 quadriplegic patient with increasing lower extremity spasticity demonstrated significant decompression by imaging but did not result in clinical improvement. A surgical procedure to decompress the syrinx was not performed on the basis of this information. In Case 2, percutaneous drainage of a large syrinx in a quadriplegic patient with increasing upper extremity numbness and weakness demonstrated significant decompression by imaging and resulted in sustained clinical improvement, temporarily obviating the need for surgery. In Case 3, percutaneous drainage of the rostral aspect of a septated syrinx cavity in a patient with a Chiari I malformation and a syringoperitoneal shunt in place resulted in decompression by imaging but failed to relieve the patient's newly developed symptoms. An additional shunt was therefore not placed. In no case did the patient experience periprocedural complications or worsening of symptoms. Conclusion: CT-guided percutaneous drainage of syringomyelia is a safe and successful technique. It can be used diagnostically to identify patients that may or may not benefit from surgical syrinx decompression and in some cases may provide a temporary therapeutic alternative to surgery.