Syringomyelia: a neurological and surgical spectrum

Because of the variation in the natural history, anatomy, surgical treatment, and follow-up periods reported to date, very few firm conclusions can be drawn regarding syringomyelia. With the advent of magnetic resonance scanning, cases of syringomyelia are being detected earlier and a better understanding of the disease has been facilitated. The authors report their personal experiences with 21 patients followed for 5-20 years. No single surgical procedure appears to predictably remedy any syrinx for more than a brief period of several years. Complete collapse of the syrinx does not eradicate all symptoms. Direct treatment of the syrinx makes intuitive sense for those syrinxes that do not communicate with the fourth ventricle. On the other hand, for syrinxes that are likely to communicate with the fourth ventricle, shunting of the ventricular system, particularly where ventriculomegaly exists (i.e., any degree of radiographic evidence of ventricular enlargement), should be considered initially. Procedures such as posterior fossa decompression may be necessary as dictated by the neurological condition of the patient. In the authors' experience, shunting procedures provided better improvement, with longer duration of improvement than with posterior fossa decompression. The timing and surgical details of posterior fossa decompression remain to be elucidated.