Neurological deterioration after posterior fossa decompression for adult syringomyelia: Proposal for a summarized treatment algorithm

This study addresses the problem of patients with syringomyelia who experience new neurological symptoms after undergoing posterior fossa decompression (PFD). The study summarizes the authors' experience with patients for whom PFD has failed. The study reviewed 85 patients with failed PFD, categorizing them into three groups based on the underlying pathologies causing the failure. These groups included insufficient decompression, craniocervical instability, and local spinal pathology. Based on the findings, the authors propose a treatment algorithm to assist surgeons in making therapeutic decisions for patients experiencing neurological deterioration after PFD.

• 1
  Recurrent cerebrospinal fluid flow obstruction at the foramen magnum is not the only cause of PFD failure; spinal pathologies and craniocervical instabilities can also contribute.
• 2
  Patients with neuropathic pain significantly improved in Group I (Foramen magnum and foramen of Magendie dredging), while swallowing improved in Group II (craniocervical fixation) within 1 year after surgery.
• 3
  In the long term, the late postoperative deterioration-free possibility in Group II was better than in Group I, and all patients in Group III improved.