Survival Analysis of Syringopleural, Syringoperitoneal, and Syringosubarachnoid Shunts for Syringomyelia: A Single-Center Retrospective Cohort Study

Study Design: This study was a retrospective single-center cohort study.Purpose: This study aimed to compare long-term shunt patency by shunt type (syringo-subarachnoid [SS], syringo-pleural [SP], syringo-peritoneal [SPt]) and disease etiology (post-traumatic, post-infectious, idiopathic) in patients surgically treated for syringomyelia, using Kaplan-Meier survival methodology.Overview of Literature: Syringomyelia shunting carries a well-documented revision burden, but direct comparative survival data across shunt modalities and etiologic subgroups are scarce, particularly from East Asian centers.Methods: We retrospectively analyzed 42 patients (mean age, 47.6±11.8 years; 57.1% male) who underwent syringomyelia shunting at a tertiary neurosurgical center (January 2000–December 2020) with ≥12 months follow-up. Shunt type was classified as SS (n=12), SP (n=16), or SPt (n=14); etiology as post-traumatic (n=24), post-infectious (n=10), idiopathic (n=6), or hemorrhage/tumor-related (n=2). The primary endpoint was shunt revision surgery. Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards regression were performed.Results: Over a median follow-up of 15 months (range, 12 to 184 months), 16 patients (38.1%) underwent shunt revision. Overall 12- and 24-month patency rates were 79.6% and 72.5%, respectively (median shunt survival 72 months). By shunt type, 12-month patency was 75.0% (SS), 81.3% (SP), and 85.7% (SPt); 24-month patency declined to 48.2% for SS while SP and SPt remained at 81.3% and 85.7% (log-rank p=0.248). Post-infectious syringomyelia showed the shortest median shunt survival (36 months) compared with post-traumatic (not reached) and idiopathic (not reached) groups (log-rank p=0.232). No independent predictor of shunt failure was identified on multivariate Cox regression.Conclusion: All three shunting techniques achieve approximately 80% one-year patency. SS may carry a higher long-term occlusion risk. Post-infectious syringomyelia requires closer postoperative surveillance. Larger prospective studies are needed to establish definitive shunt selection criteria.