Skip to main content
SpringerLink
Log in

Surgical management of syringomyelia unrelated to Chiari malformation or spinal cord injury

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Syringomyelia is a misleading disease since the problem always lies elsewhere. Arachnoiditis, because it is radiographically difficult to discern, is an especially insidious cause. To better guide selection from among surgical treatment options for syringomyelia, we reviewed our case series of patients without Chiari malformation or spinal injury.

Methods

Excluding syringomyelia due to Chiari malformation, spinal cord injury, and tumors, 32 patients (mean age 44 years) were operated on between 1995 and 2013 and followed up for a mean of 53.8 months. Presumed causes at diagnosis, clinical and radiological findings, type of operation, clinical and radiological outcome were reviewed.

Results

Duration of clinical history varied widely (range 6–164 months). Clinical assessment was based on the McCormick classification (15 independent, 17 dependent). Causes included birth trauma, pyogenic meningitis, tuberculous meningitis, postoperative scarring, dysraphism, and basilar impression. Treatment was local decompression with arachnoid lysis and shunts. Hindbrain-related syringomyelia was differentiated from non hindbrain-related syringomyelia. Hindbrain arachnoiditis was significantly associated with radiological findings at the foramen magnum (p = 0.01) and craniocervical decompression (p < 0.03), with good clinical and radiological outcome at 6 months and later follow-up controls (p = 0.02), whereas uneven results were observed in cases of non-hindbrain arachnoiditis.

Conclusions

To remove the cause of syringomyelia, surgical planning will rely on thorough clinical history and accurate imaging to determine the site of cerebrospinal fluid obstruction. Craniocervical decompression to dissect basal arachnoiditis in the posterior fossa can be recommended in hindbrain syringomyelia. Treatment of non-hindbrain arachnoiditis is more controversial, probably owing to uncertainties about the extent of adhesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Levine DN (2004) The pathogenesis of syringomyelia associated with lesions at the foramen magnum: a critical review of existing theories and proposal of a new hypothesis. J Neurol Sci 220:3–21

    Article  PubMed  Google Scholar 

  2. Roy AK, Slimack NP, Ganju A (2011) Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management. Neurosurg Focus 31(6):E15

    Article  PubMed  Google Scholar 

  3. Batzdorf U (2005) Primary spinal syringomyelia. J Neurosurg Spine 3:429–435

    Article  PubMed  Google Scholar 

  4. Greitz D (2006) Unraveling the riddle of syringomyelia. Neurosurg Rev 29:251–264

    Article  PubMed  Google Scholar 

  5. Oldfield EH, Muraszko K, Shawker TH, Patronas NJ (1994) Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils; implication for diagnosis and treatment. J Neurosurg 80:3–15

    Article  CAS  PubMed  Google Scholar 

  6. Pillay PK, Awad IA, Little JR, Hahn JF (1991) Surgical management of syringomyelia: a five year experience in the era of magnetic resonance imaging. Neurol Res 13:3–9

    CAS  PubMed  Google Scholar 

  7. Biyani A, El Masry WS (1994) Post-traumatic syringomyelia: a review of the literature. Paraplegia 32:723–731

    Article  CAS  PubMed  Google Scholar 

  8. Simmons JD, Norman D, Newton TH (1983) Preoperative demonstration of postinflammatory syringomyelia. AJNR 4:625–628

    CAS  PubMed  Google Scholar 

  9. Mauer UM, Freude G, Danz B, Kunz U (2008) Cardiac-gated phase-contrast magnetic resonance imaging of cerebrospinal fluid flow in the diagnosis of idiopathic syringomyelia. Neurosurgery 63:1139–1144

    Article  PubMed  Google Scholar 

  10. Barnett HJM, Foster JB, Hudgson D (1973) Syringomyelia. WB Saunders, London, pp 1–318

    Google Scholar 

  11. Chamberlain WE (1939) Basilar impression (platybasia). Yale J Biol Med 11:487–496

    CAS  PubMed  PubMed Central  Google Scholar 

  12. McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532

    Article  CAS  PubMed  Google Scholar 

  13. Klekamp J, Batzdorf U, Samii M, Bothe HW (1997) Treatment of syringomyelia associated with arachnoid scarring caused by arachnoiditis or trauma. J Neurosurg 86:233–240

    Article  CAS  PubMed  Google Scholar 

  14. Williams B (1969) The distending force in the production of “communicating syringomyelia”. Lancet 2:189–193

    Article  CAS  PubMed  Google Scholar 

  15. Gardner WJ (1965) Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry 28:247–259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Goel A, Desai K (2000) Surgery for syringomyelia: an analysis based on 163 surgical cases. Acta Neurochir 142:293–302

    Article  CAS  PubMed  Google Scholar 

  17. Williams B (1993) Pathogenesis of syringomyelia. Acta Neurochir 123(3–4):159–165

    CAS  PubMed  Google Scholar 

  18. Lee JH, Chung CK, Kim HJ (2002) Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation. Spinal Cord 40:501–506

    Article  PubMed  Google Scholar 

  19. Appleby A, Bradley WG, Foster JB, Hankinson J, Hudgson P (1969) Syringomyelia due to chronic arachnoiditis at the foramen magnum. J Neurosurg Sci 8:451–464

    CAS  Google Scholar 

  20. Gimenz-Roldan S, Esteban A, Benito C (1974) Communicating syringomyelia following cured tuberculous meningitis. J Neurol Sci 23:185–197

    Article  Google Scholar 

  21. Caplan LR, Norohna AB, Amico LL (1990) Syringomyelia and arachnoiditis. J Neurol Neurosurg Psychiatry 53:106–113

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Milhorat TH, Capocelli AL, Anzil AP, Kotzen RM, Milhorat RH (1995) Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg 82:802–812

    Article  CAS  PubMed  Google Scholar 

  23. Iskandar BJ, Hedlund GL, Grabb PA, Oakes WJ (1998) The resolution of syringohydromyelia without hindbrain herniation after posterior fossa decompression. J Neurosurg 89:212–216

    Article  CAS  PubMed  Google Scholar 

  24. Kyoshima K, Kuroyanagi T, Oya F, Kamijo Y, El-Noamany H, Kobayashi S (2002) Syringomyelia without hindbrain herniation: tight cisterna magna. Report of four cases and a review of the literature. J Neurosurg 96(2 Suppl):239–249

    PubMed  Google Scholar 

  25. Grant R, Hadley DM, Lang D, Condon B, Johnston R, Bone I, Teasdale GM (1987) MRI measurement of syrinx size before and after operation. J Neurol Neurosurg Psychiatry 50:1685–1687

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Schlesinger EB, Antunes JL, Michelsen WJ, Louis KM (1981) Hydromyelia: clinical presentation and comparison of modalities of treatment. Neurosurgery 9:356–365

    Article  CAS  PubMed  Google Scholar 

  27. Logue V, Edwards MR (1981) Syringomyelia and its surgical treatment—an analysis of 75 patients. J Neurol Neurosurg Psychiatry 44:273–284

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Wisoff JH, Epstein F (1989) Management of hydromyelia. Neurosurgery 25:562–571

    Article  CAS  PubMed  Google Scholar 

  29. Versari PP, D’Aliberti G, Talamonti G, Collice M (1993) Foraminal syringomyelia: suggestion for a grading system. Acta Neurochir 125:97–104

    Article  CAS  PubMed  Google Scholar 

  30. Aboulker J (1979) La syringomyelie et les liquides intra-rachidiens. Neurochirurgie 25(Suppl 1):1–144

    Google Scholar 

  31. Sgouros S, Williams B (1995) A critical appraisal of drainage in syringomyelia. J Neurosurg 82:1–10

    Article  CAS  PubMed  Google Scholar 

  32. Batzdorf U, Klekamp J, Johnson P (1998) A critical appraisal of syrinx cavity shunting procedure. J Neurosurg 89:382–388

    Article  CAS  PubMed  Google Scholar 

  33. Nakamura M, Ishii K, Watanabe K, Tsuji T, Matsumoto M, Toyama Y et al (2009) Clinical significance and prognosis of idiopathic syringomyelia. J Spinal Disord Tech 22:372–375

    Article  PubMed  Google Scholar 

  34. Tanghe HLJ (1995) Magnetic resonance imaging (MRI) in syringomyelia. Acta Neurochir 134:93–99

    Article  CAS  PubMed  Google Scholar 

  35. Inoue Y, Nemoto Y, Ohata K, Daikokuya H, Hakuba A, Tashiro T et al (2001) Syringomyelia associated with adhesive spinal arachnoiditis: MRI. Neuroradiology 43:325–330

    Article  CAS  PubMed  Google Scholar 

  36. Roser F, Ebner FH, Danz S, Riether F, Ritz R, Dietz K et al (2008) Three-dimensional constructive interference in steady-state magnetic resonance imaging in syringomyelia: advantages over conventional imaging. J Neurosurg Spine 8:429–435

    Article  PubMed  Google Scholar 

  37. Reardon MA, Raghavan P, Carpenter-Bailey K, Mukherjee S, Smith JS, Matsumoto JA et al (2013) Dorsal thoracic arachnoid web and the “scalpel sign”: a distinct clinical-radiologic entity. AJNR 34(5):1104–1110

    Article  CAS  PubMed  Google Scholar 

  38. Armonda RA, Citrin CM, Foley KT, Ellenbogen RG (1994) Quantitative cine-mode magnetic resonance imaging of Chiari I malformations: an analysis of cerebrospinal fluid dynamics. Neurosurgery 35:214–224

    Article  CAS  PubMed  Google Scholar 

  39. Gottschalk A, Schmitz B, Mauer UM, Bornstedt A, Steinhoff S, Danz B et al (2010) Dynamic visualization of arachnoid adhesion in a patient with idiopathic syringomyelia using high-resolution cine magnetic resonance imaging at 3T. J Magn Reson Imaging 32:218–222

    Article  PubMed  Google Scholar 

  40. Klekamp J (2013) Treatment of syringomyelia related to nontraumatic arachnoid pathologies of the spinal canal. Neurosurgery 72:376–389

    Article  PubMed  Google Scholar 

  41. Ohata K, Gotoh T, Matsusaka Y, Morino M, Tsuyuguchi N, Sheikh B et al (2001) Surgical management of syringomyelia associated with spinal adhesive arachnoiditis; technical note. J Clin Neurosci 8:40–42

    Article  CAS  PubMed  Google Scholar 

  42. Koyanagi I, Iwasaki Y, Hida K, Houkin K (2005) Clinical features and pathomechanisms of syringomyelia associated with spinal arachnoiditis. Surg Neurol 63:350–356

    Article  PubMed  Google Scholar 

  43. Milhorat TH, Miller JI, Johnson WD, Adler DE, Heger IM (1993) Anatomical basis of syringomyelia occurring with hindbrain lesions. Neurosurgery 32:748–754

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Neurosurgery, Department of Neurological, Biomedical and Movement Sciences, University Hospital, University of Verona, P. Stefani 1, 37126, Verona, Italy

    Andrea Talacchi & Pietro Meneghelli

  2. Unit of Neurosurgery, Maria Cecilia Hospital, Cotignola, Ravenna, Italy

    Ignazio Borghesi

  3. Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy

    Francesca Locatelli

Authors
  1. Andrea Talacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pietro Meneghelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ignazio Borghesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Locatelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Talacchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Talacchi, A., Meneghelli, P., Borghesi, I. et al. Surgical management of syringomyelia unrelated to Chiari malformation or spinal cord injury. Eur Spine J 25, 1836–1846 (2016). https://doi.org/10.1007/s00586-015-4262-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-4262-x

Keywords

Search

Navigation