Syringomyelia

Diagnostic imaging has significantly increased the number of syringomyelia cases detected in the beginning stages of the disorder. Physicians primarily use magnetic resonance imaging (MRI) to diagnose syringomyelia. Computer-generated radio waves and a powerful magnetic field produce images of body structures, such as the brain and spinal cord, in vivid detail. This test will show the syrinx in the spine as well as other conditions, such as the presence of a tumor. Images taken in rapid succession can be used for “dynamic imaging” (in “cine mode”) to observe the fluid flowing around the spinal cord and within the syrinx. Computed tomography (CT), which uses x-rays and a computerized scanner to produce cross-sectional images of the body or an organ structure, may reveal the presence of tumors and other abnormalities such as hydrocephalus. Another test, called a myelogram, takes x-ray-like pictures and requires a contrast medium or dye to do so. Since the introduction of MRI this test is rarely necessary to diagnose syringomyelia.


Surgery is usually recommended for individuals with syringomyelia. The type of surgery and its location depend on the type of syringomyelia. In Chiari malformation, the main goal of surgery is to provide more space at the base of the skull and upper neck, without entering the brain or spinal cord. This results in the primary cyst becoming much smaller. Surgery results in stabilization or modest improvement in symptoms for most individuals with Chiari malformation. Delay in treatment may result in irreversible spinal cord injury. Recurrence of syringomyelia after surgery may make additional operations necessary; these may not be completely successful over the long term.

In some individuals it may be necessary to drain the syrinx, which can be accomplished using a catheter, drainage tubes, and valves. This system is known as a shunt. Shunts are used in both the communicating and noncommunicating forms of the disorder. First, the surgeon must locate the syrinx. Then, the shunt is placed into it with the other end draining the syrinx fluid into a cavity, usually the abdomen. This type of shunt is called a syringoperitoneal shunt. A shunt of CSF from the brain to the abdomen is called a ventriculoperitoneal shunt and is used in cases involving hydrocephalus. By draining syrinx fluid or CSF, a shunt can halt the progression of symptoms and relieve pain, headache, and tightness. Without correction, symptoms generally continue.

The decision to use a shunt requires extensive discussion between the surgeon and the individual, as this procedure carries with it the risk of injury to the spinal cord, infection, blockage, or hemorrhage and may not necessarily work for all people.

If a tumor is causing syringomyelia, removing the tumor is the treatment of choice and almost always eliminates the syrinx.

In the case of trauma-related syringomyelia, the preferred surgical approach is to operate at the level of the initial injury to expand the space around the spinal cord and decrease fluid volume. This operation is performed outside the spinal cord. An alternate operation is to place a shunt in the syrinx, which requires a hole to be made in the spinal cord. Shunts may injure the spinal cord and may require replacement if they clog over time. Many surgeons now consider shunt placement only as a last resort. Instead, surgeons usually choose to expand the space around the spinal cord. This is done by removing scar tissue that “tethers” the cord in place and prevents the free flow of CSF around it, and adding a patch to expand the “dura,” the membrane that surrounds the spinal cord and contains the CSF (a procedure called expansive duraplasty). In some cases, the vertebrae may need to be realigned to correct spinal deformity that is narrowing the spinal column.

Many spinal cord-injured individuals have a cyst at the site of the original injury. These cysts do not always require treatment, although treatment may be warranted if a cyst grows larger or begins to cause symptoms.

Drugs have no curative value as a treatment for syringomyelia but may be used to ease pain. Radiation is used rarely and is of little benefit except in the presence of a tumor. In these cases, it can halt the extension of a cavity and may help to alleviate pain.

In the absence of symptoms, syringomyelia is usually not treated. In addition, a physician may recommend not treating the condition in individuals of advanced age or in cases where there is no progression of symptoms. Whether treated or not, many individuals will be told to avoid activities that involve straining.

DJ, Chiari malformation is a very serious condition, as is any  type of syringomyelia.  These are conditions that do not get well usually without surgery, and it is always very risky when operating near brain stem.

Thank you, keithbruce!  Actually Matt has not been scheduled for surgery, due to poor insurance with high deductible and co-pay that make it out of reach for his family.  But he is doing better, remarkably so.  I thank you all for your well wishes, which I have passed on to him.  Because of his limited cognitive ability, I did not share such a technical article, but did share it with his mother.  Some people just don't want to know, would rather be in the dark and not feel responsible for making care choices.  Maybe it's out of frustration with knowing that with limited income, there isn't that much choice.  I'm just grateful that Matt seems to be functioning better than he had been.

Indeed. Hope you're doing well wavewolf, it's good to see you on here!