[Treatment of syringomyelia]

Treatment of syringomyelia utilizes two operative approaches: posterior fossa decompression and syrinx shunting (including subarachnoid, pleural and peritoneal shunting). MRI study is nowadays the indispensable tool for the evaluation of patients with syringomyelia and allows to choose the best therapeutic option. Posterior fossa decompression is regarded as the procedure of choice for syringomyelia with Chiari. After intradural exploration, additional steps may be necessary as excision of the cerebellar tonsils. Other therapeutic alternatives are associated with higher complication rates. Patients with persistent focal syrinxes after PFD respond best to syringoperitoneal shunts. For the management of post-traumatic syringomyelia, a large decompressive laminectomy at the fracture site is recommended; the use of a drain does not offer any long-term therapeutic advantage. Syringoperitoneal shunting is the treatment of post-infection syringomyelia but good long-term result is rare in this type of syrinx.