Abstract
The incidentally detected syringomyelia on magnetic resonance imaging remains a management dilemma. The terminologies like “syringomyelia” and “hydromyelia” have been used interchangeably but bear different connotations scientifically. The dilation of central canal due to alteration in cerebrospinal spinal dynamics is syringomyelia, whereas formation of cavities inside gray matter of spinal cord after infective, traumatic, or neoplastic pathology should be termed “hydromyelia.” The axial diameter of the central canal ranges from 2 to 4 mm, which usually decreases with age; and any diameter more than that is considered to be manifesting as syringomyelia. There is no level I evidence for the timing of surgical intervention for an asymptomatic syringomyelia. Routine radiological follow-up is needed, and associated cranio-vertebral junction anomalies must be ruled out. The management depends upon the rate of progression and the severity of neurological deficit involved. In our chapter, we have briefly discussed the pathogenesis of syrinx formation, various occult associations, and have highlighted management of the entity. We believe that the size of syrinx usually does not show any correlation with symptoms and the severity of manifestations. Early intervention may lead to a cessation in the disease progression.
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Abbreviations
- CSF:
-
Cerebrospinal fluid
- MRI:
-
Magnetic resonance imaging
References
Roy AK, Slimack NP, Ganju A. Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management. Neurosurg Focus. 2011;31(6):E15. https://doi.org/10.3171/2011.9.FOCUS11198.
Hamlat A, Le Strat A, Boisselier P, Brassier G, Carsin-Nicol B. Asymptomatic syringomyelia in the course of medulloblastoma. Pediatr Neurosurg. 2005;41(5):258–63. https://doi.org/10.1159/000087485.
Zhou JJ, Xu JF, Zheng XN, Peng GP. Asymptomatic syringomyelia accompanied with metastatic cerebellar and spinal intramedullary lymphoma: a case report. Medicine (Baltimore). 2017;96(46):e8593. https://doi.org/10.1097/MD.0000000000008593.
Pasoglou V, Janin N, Tebache M, Tegos TJ, Born JD, Collignon L. Familial adhesive arachnoiditis associated with syringomyelia. AJNR Am J Neuroradiol. 2014;35(6):1232–6. https://doi.org/10.3174/ajnr.A3858.
Giner J, Pérez López C, Hernández B, Gómez de la Riva Á, Isla A, Roda JM. Update on the pathophysiology and management of syringomyelia unrelated to Chiari malformation. Neurologia (Engl Ed). 2019;34(5):318–25. https://doi.org/10.1016/j.nrl.2016.09.010.
Wen N, Zhao F, Zhu Y, Jia F, Wan C, Wen Y. Acute development of syringomyelia following TBM in a pediatric case. BMC Pediatr. 2021;21(1):36. https://doi.org/10.1186/s12887-021-02493-7.
Sakushima K, Tsuboi S, Yabe I, Hida K, Terae S, Uehara R, Nakano I, Sasaki H. Nationwide survey on the epidemiology of syringomyelia in Japan. J Neurol Sci. 2012;313(1–2):147–52. https://doi.org/10.1016/j.jns.2011.08.045.
Koyanagi I, Iwasaki Y, Hida K, Houkin K. Clinical features and pathomechanisms of syringomyelia associated with spinal arachnoiditis. Surg Neurol. 2005;63(4):350–5. https://doi.org/10.1016/j.surneu.2004.05.038.
Biyani A, el Masry WS. Post-traumatic syringomyelia: a review of the literature. Paraplegia. 1994;32(11):723–31. https://doi.org/10.1038/sc.1994.117.
Kleindienst A, Engelhorn T, Roeckelein V, et al. Development of pre-syrinx state and syringomyelia following a minor injury: a case report. J Med Case Rep. 2020;14:223. https://doi.org/10.1186/s13256-020-02568-6.
Brammah TB, Jayson MI. Syringomyelia as a complication of spinal arachnoiditis. Spine (Phila Pa 1976). 1994;19(22):2603–5. https://doi.org/10.1097/00007632-199411001-00019.
Abel TJ, Howard MA, Menezes A. Syringomyelia and spinal arachnoiditis resulting from aneurysmal subarachnoid hemorrhage: report of two cases and review of the literature. J Craniovertebr Junction Spine. 2014;5:47–51.
Stoodley MA, Gutschmidt B, Jones NR. Cerebrospinal fluid flow in an animal model of noncommunicating syringomyelia. Neurosurgery. 1999;44(5):1065–75. https://doi.org/10.1097/00006123-199905000-00068.
Batzdorf U. Primary spinal syringomyelia. J Neurosurg Spine. 2005;3:429–35.
Heiss JD, Suffredini G, Smith R, DeVroom HL, Patronas NJ, Butman JA, et al. Pathophysiology of persistent syringomyelia after decompressive craniocervical surgery. J Neurosurg Spine. 2010;13:729–42.
Oldfield EH, Muraszko K, Shawker TH, Patronas NJ. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg. 1994;80:3–15.
Williams B. Simultaneous cerebral and spinal fluid pressure recordings. 2. Cerebrospinal dissociation with lesions at the foramen magnum. Acta Neurochir (Wien). 1981;59:123–42.
Chang HS, Nakagawa H. Hypothesis on the pathophysiology of syringomyelia based on simulation of cerebrospinal fluid dynamics. J Neurol Neurosurg Psychiatry. 2003;74(3):344–7. https://doi.org/10.1136/jnnp.74.3.344.
Muthukumar N. Terminal syringomyelia communicating with a spinal dermal sinus. J Clin Neurosci. 2007;14(7):688–90. https://doi.org/10.1016/j.jocn.2006.02.013.
Li YD, Therasse C, Kesavabhotia K, Lamano JB, Ganju A. Radiographic assessment of surgical treatment of post-traumatic syringomyelia. J Spinal Cord Med. 2021;44(6):861–9.
Pang D, Dias MS, Ahab-Barmada M. Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery. 1992;31(3):451–80. https://doi.org/10.1227/00006123-199209000-00010.
Nakamura M, Ishii K, Watanabe K, Tsuji T, Matsumoto M, Toyama Y, Chiba K. Clinical significance and prognosis of idiopathic syringomyelia. J Spinal Disord Tech. 2009;22(5):372–5. https://doi.org/10.1097/BSD.0b013e3181761543.
Rangari K, Das KK, Singh S, Kumar KG, Bhaisora KS, Sardhara J, et al. Type I Chiari malformation without concomitant bony instability: assessment of different surgical procedures and outcomes in 73 patients. Neurospine. 2021;18(1):126–138.
Kersey J, Cato-Addison W, Holliman D. Iatrogenic syringomyelia secondary to lumboperitoneal shunt altered by the raised intra-abdominal pressure of pregnancy. Br J Neurosurg. 2017;32(6):684–5. https://doi.org/10.1080/02688697.2017.1297369.
Kurzbuch AR, Magdum S. Iatrogenic syringomyelia postcranial surgery in pediatric patients: systematic review and illustrative case. Childs Nerv Syst. 2021;37(9):2879–90. https://doi.org/10.1007/s00381-021-05268-8.
Arora P, Behari S, Banerji D, Chhabra DK, Jain VK. Factors influencing the outcome in symptomatic Chiari I malformation. Neurol India. 2004;52(4):470–4.
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Singh, S., Shukla, A., Mishra, A.K., Behari, S. (2023). Asymptomatic Hydromyelia and Syringomyelia. In: Turgut, M., Guo, F., Turgut, A.T., Behari, S. (eds) Incidental Findings of the Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-031-42595-0_27
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