Comparative outcomes of syringopleural, syringosubarachnoid, and syringoperitoneal shunts for syringomyelia: a single-center retrospective cohort study.

Abstract

Syringomyelia is a progressive neurological disorder characterized by intramedullary fluid-filled cavities. Shunt placement remains a key treatment option when decompression fails, yet comparative outcomes across shunt types remain poorly defined. The aim of this study was to compare revision rates, time to failure, and neurological outcomes among patients treated with syringopleural, syringosubarachnoid, and syringoperitoneal shunts. A retrospective review was conducted using a prospectively maintained database of the senior surgeon from 1997 to 2025 to identify patients who underwent syrinx shunt placement. Demographic data, shunt type, revision rates, time to revision, and neurological outcomes at early and late follow-up time points were analyzed. Revision was defined as a return to the operating room for shunt-related complications. Thirty-one patients (19 male, mean age 47.2 years) underwent 48 surgeries for placement of syringopleural (n = 20, 41.7%), syringosubarachnoid (n = 21, 43.8%), and syringoperitoneal (n = 7, 14.6%) shunts. Common etiologies included traumatic injury and Chiari malformation. Ten patients (32.2%) required at least one revision surgery, while 21 patients (67.7%) did not require revision. The mean hospital length of stay was significantly longer for syringosubarachnoid (10.1 days) and syringoperitoneal (10.0 days) compared with syringopleural (5.4 days) surgeries (p = 0.036). Revision rates were highest for syringopleural shunts (55.0%), followed by syringoperitoneal (28.6%) and syringosubarachnoid (19.0%) (p = 0.003). Early motor and/or sensory function improvement was observed in 55.0% of syringopleural cases, 33.3% of syringosubarachnoid cases, and 14.3% of syringoperitoneal cases (p = 0.117). Sustained long-term improvement was rare across all groups (p = 0.551). The mean time to revision surgery was 1093 days for syringopleural, 515 days for syringosubarachnoid, and 89 days for syringoperitoneal shunts (p = 0.144). Syrinx shunting provided modest early neurological benefit, but long-term durability remained limited. Syringopleural shunts demonstrated greater early clinical improvement but carried greater revision risk. Syringosubarachnoid shunts had lower mechanical failure rates but limited clinical efficacy. Optimizing patient selection and vigilant postoperative monitoring are crucial. Further research is needed to refine surgical strategies and improve durable outcomes.