Syringomyelia

Diagnosis

The following will assist the healthcare provider in diagnosing syringomyelia:

• Physical examination: Diagnosing syringomyelia involves a review of one’s medical history, a neurological-focused physical examination, and imaging tests. In some cases, syringomyelia may be detected during a test performed for other reasons.
• Magnetic resonance imaging (MRI): MRI scans can identify if there is a syrinx or any other abnormalities like tumors in your spine. It clearly shows the location, size, and severity of the syrinx.
  An MRI scan of the spine and spinal cord is the most reliable method for diagnosing syringomyelia as it provides detailed images using radio waves and a magnetic field.
• Myelogram with computed tomography (CT) scan: A myelogram is a test that uses a contrast dye and computed tomography to examine your spinal canal for any issues. This may be recommended for people who cannot have an MRI.

Treatment

Treatment for syringomyelia depends on symptom severity and progression. Generally, if it is causing symptoms, treatment typically involves surgery aimed at addressing the underlying cause and preventing further spinal cord damage.

Treatment options include:

• Periodic monitoring: This involves going through periodic MRI scans and neurological exams to check the syringomyelia. This may be recommended if syringomyelia is asymptomatic.
• Surgery: There are two main types of surgery: one focuses on restoring normal cerebrospinal fluid (CSF) flow around the spinal cord, while the other involves directly draining the syrinx. The choice of surgical approach depends on the underlying cause of the symptoms.
  The aim of surgery is to alleviate pressure on the spinal cord caused by the syrinx and restore normal cerebrospinal fluid flow. This can lead to symptom improvement and better nervous system function.
  Surgical treatments include:
  • Treating Chiari malformation: This surgery can help drain a syrinx, which may shrink or vanish completely. Even if the syrinx does not change much, surgery can still improve symptoms. The procedure involves removing a small section of bone at the back of the skull.
  • Removing the blockage: Surgery to remove blockages like scar tissue, bone, or tumors from your spinal canal can fix the normal flow of fluid in your brain and spine. In some cases, if a tumor is causing the syrinx, radiation therapy may be suggested to make the tumor smaller.
  • Draining the syrinx: If the cause of the syrinx is unknown and it is getting bigger, draining it might be recommended. In this procedure, a drain called a stent or shunt is placed into the syrinx. The tubing has two ends: one is inserted into the syrinx and the other into a different part of the body, such the abdomen. Both of these methods can help prevent symptoms from getting worse.
  • Fixing the irregularity: Surgery to help the fluid flow properly and drain a syrinx may be recommended, if the problem is a tethered spinal cord, or the spine blocking the flow of cerebrospinal fluid.
• Follow-up care: Following surgery, healthcare providers will utilize MRI scans to assess the syrinx’s condition, observing whether it is improving or maintaining its size. Additional MRIs may be necessary to evaluate the effectiveness of the surgery. Despite treatment, certain symptoms may persist due to the lasting damage inflicted by the syrinx on the spinal cord and nerves. Furthermore, the syrinx may enlarge over time, necessitating further intervention. Regular check-ups are essential to monitor for any recurrence of syringomyelia.