Gardner's hydrodynamic theory of syringomyelia revisited

Several theories have been put forth to explain the pathogenesis of syringomyelia, the formation of longitudinal, fluid-filled cavities within the spinal cord. Chief among them is Gardner's hydrodynamic theory, widely accepted for more than two decades. Gardner attributed the genesis of syringomyelia to craniospinal pressure differentials in the setting of fourth ventricular outlet obstruction; these differentials favor cerebrospinal fluid shifts from the fourth ventricle of the brain through the central canal of the spinal cord. Gardner's theory has been questioned, and several alternative theories of syringomyelia have been proposed. Physiological data and new information from magnetic resonance imaging support many of Gardner's concepts; however, a more comprehensive elucidation of the pathophysiologic mechanisms of syringomyelia requires incorporating facets of the other theories. We propose a unified theory of the pathogenesis of syringomyelia based on recent experience with magnetic resonance imaging, and on elements of other current theories.