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    A simple technique for thoracoscopic assisted placement of the distal limb of syringopleural shunts

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    Author
    Bonatti, H.J.
    Kurtom, K.H.
    Date
    2018
    Journal
    Respiratory Medicine Case Reports
    Publisher
    W.B. Saunders Ltd
    Type
    Article
    
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    See at
    https://dx.doi.org/10.1016/j.rmcr.2018.09.011
    Abstract
    Background: Syringomyelia is an unusual accumulation of fluid within the spinal cord that may be associated with significant neurologic symptoms. Surgical drainage using various techniques is often required to reduce the intraparenchymal pressure and to alleviate symptoms. Syringopleural shunting seems to produce best results. Patients and methods: A simple technique to insert the distal limb of the syringopleural shunt into the pleural space is described in detail. The patient is placed in prone position. The syrinx is accessed from a dorsal incision and the proximal limb is inserted into the fluid cavity. The tube is tunneled through the subcutaneous space laterally and caudally. A 5mm blunt port is inserted lateral to the scapula and advanced under visual control using a 5mm 30� camera through the subcutaneous tissue and muscle and at the upper border of the 5th rib through the intercostals. With ventilation paused, the pleura is penetrated and CO2 is insufflated with a pressure of 8mm mercury. Under visual control the distal limb of the shunt is inserted at the pleural recessus and the tube is directed cranially. Positive airway pressure is applied re-expanding the lung. The trocar is removed from the pleural cavity and the skin is closed with subcuticular sutures. Results: The shunt was successfully placed in three consecutive cases including one redo case (1 male, 1 female aged 50 and 51 years with post traumatic syrinx). Postoperative chest x-ray excluded pneumothorax and no chest tube was required. Neurologic improvement was achieved in both patients. Conclusions: General surgeons should be familiar with this simple technique similar to laparoscopic assisted placement of distal ventriculoperitoneal shunt catheters into the abdominal cavity. � 2018 The Authors
    Keyword
    Syringomyelia
    Syringopleural shunt
    Thoracoscopy
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054193168&doi=10.1016%2fj.rmcr.2018.09.011&partnerID=40&md5=b252416ad58ffe397e68ef101059e8d7; http://hdl.handle.net/10713/8825
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.rmcr.2018.09.011
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