A Novel Surgical Technique for Post-traumatic Syringomyelia Progressing to the Medulla Oblongata: Evidence of Upward Drainage of Central Canal Fluid Within the Spinal Cord

作者：Chenghua Yuan, Zhencheng Xiong, Houyuan Lv, Chenyuan Ding, Pingchuan Xia, Huixin Xue, Hui Zhan, Mingchu Li, Yueqi Du, Can Zhang, Zhenlei Liu, Kai Wang, Wanru Duan, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen, Fengzeng Jian, Jian Guan · 发表于：Neurosurgery · 年份：2025 · DOI：10.1227/neu.0000000000003378 · 被引用次数：7 · 研究领域：Spinal Dysraphism and Malformations、Spinal Cord Injury Research、Scoliosis diagnosis and treatment

BACKGROUND AND OBJECTIVES: The exact pathways of fluid outflow within the central canal (CC) of the spinal cord are not completely understood. The best management approach for patients with post-traumatic syringomyelia that progresses to the cranial end of the CC, also known as post-traumatic syringobulbia (PT-syringobulbia), is still a topic of debate. This study aims to introduce a new surgical indication for the foramen magnum and foramen of Magendie dredging (FMMD) procedure in patients with PT-syringobulbia and prospectively assess its surgical outcomes. METHODS: The study included 15 consecutive patients with symptomatic PT-syringobulbia who underwent the FMMD procedure and 20 patients who underwent traditional arachnolysis. The surgical procedure included decompression of the foramen magnum, removal of all potential intradural factors, and clearance of any possible obstructions at the foramen magnum and the foramen of Magendie. The major presenting symptoms or signs were assessed in terms of symptom improvement, stabilization, or deterioration. Preoperative MRI and postoperative MRI were used to assess syringobulbia resolution. The mean follow-up period was 24 months (range 12-60 months). RESULTS: Twelve patients showed clinical improvement, and 3 were stable. The mean length of the syrinx observed on preoperative MRI was 17.3 spinal levels, and the mean syringobulbia/medulla oblongata index was 69%. The mean syringobulbia/medulla oblongata index observed on postoperat...