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Surgical and Non-surgical
Options for Syringomyelia

 

Syringomyelia—the development of elongated, fluid-filled cysts, or syrinxes, within the spinal cord— can arise from several causes, including Arnold-Chiari malformation. While surgery is the generally recommended treatment for syringomyelia, not all patients with the disorder require an operation.

 

As a syrinx lengthens and expands over time, it destroys the center of the spinal cord, causing pain, weakness and stiffness in the back, shoulders, arms or legs. Not all syrinxes, however, are symptomatic.

 

“Sometimes we see very small, asymptomatic syrinxes that don’t increase over time,” says E. Scott Conner, MD, neurosurgeon at the Santa Barbara Neurosciences Institute at Cottage Health System. “Syrinxes can also be chronic but asymptomatic."

 

 

E. Scott Conner, MD

Neurosurgeon

 

 

While most cases of syringomyelia are due to Arnold-Chiari malformation (discussed in the last issue of NEUROtransmitter)—brain tissue protruding into the spinal canal—the disorder can also result from a severe spinal injury or arachnoiditis. Type II Arnold-Chiari malformation can cause a congenital form of syringomyelia in patients with spina bifida.

 

Evaluation and Surgical Considerations

The use of magnetic resonance imaging (MRI) in recent years has allowed neurosurgeons to diagnose more cases of syringomyelia in its earlier stages than in the past. “If a syrinx is progressing and displaying symptoms, it will only get worse,” Dr. Conner says. “Not all syrinxes progress in a predictable way, and some aren’t debilitating enough to necessitate surgery. Individuals for whom surgery is the best option, however, generally respond well to it.”

 

When syringomyelia is due to Arnold-Chiari malformation, an operation can be performed on the back of the skull and upper cervical spine to remove some bone and place a graft to make space for more fluid to move up and down the spine. Syringomyelia resulting from a traumatic injury or arachnoiditis can be treated by placing a shunt in the spinal cord cyst to accommodate the passage of fluid from within the cord or removing focal scar or other subarachnoid obstructions preventing the free flow of spinal fluid around the spinal cord.

The biggest recent advance in the diagnosis and treatment of syringomyelia has been the use of magnetic resonance imaging (MRI) to detect the disorder.

 

According to E. Scott Conner, MD, neurosurgeon at Santa Barbara Neuroscience Institute at Cottage Health System, MRI has greatly improved diagnosticians’ ability to confidently identify a diagnosis of Arnold-Chiari malformation.

 

Distended cervicothoracic level syrinx,
causing quadriparesis.

 

Collapsed syrinx following surgical shunt.
Patient recovered all neurologic function.

 

“Not all treatments are 100 percent effective, but a patient’s symptoms can usually be controlled,” Dr. Conner says. “An MRI is recommended one month after surgery, followed by yearly scanning depending on the patient’s situation. Syringomyelia is not a common condition, but neurosurgeons with a high level of experience and expertise are able to help patients find solutions to the disorder.”

 

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