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Syringomyelia
What is syringomyelia?
Syringomyelia means a cavity of the centre of the spinal cord, which often arises as a result of accidental injury to the spinal cord. Consequently, at the point of injury cavitation develops slowly over months or even years. Should the cavity expand, the spinal cord injury’s symptoms may gradually worsen.
Spinal cord cavitation may also originate at foetal stage as a result of a developmental disorder. Then the cavity may be related to the so-called Chiari malformation, which is a structural problem of the posterior of the skull, where the cerebellum protrudes down into the spinal canal causing congestion of the spinal cord.
The cavity in the spinal cord can also be caused by haemorrhage, infarction, infection or tumours.
The typical symptoms of spinal cord cavitation are a loss of sensation in bands, the lack of pain sensations at varying heights and at later stages also motor disorders. The typical symptom of the Chiari malformation is a strain related headache.
How is spinal cord cavitation treated?
If the spinal cord cavity is due to a Chiari malformation, then the latter is treated first. In which case, the cranial base opening is enlarged neurosurgically, so that more space is created for the hanging cerebellum and the spinal cord in front of it. The cavity may gradually contract itself, after the treatment.
In all other cases, the cavity itself is treated. If the cavity is small, it is monitored by control imaging. If the cavity is large, or if it grows significantly and causes an increase in symptoms, then neurosurgery is necessary. In this case, a hole is made into the cavity, through which a catheter is inserted. With the aid of the catheter the cavity is transformed from a bulbous shape to a hose-like shape, so that the liquid can flow out and the cavity contracts. Symptoms recede, as the internal pressure of the spine reduces.
If the spinal cord tissue has hardened into scar tissue, for example, the shape of the cavity can no longer be changed. Therefore the patient’s symptoms are unlikely to be relieved surgically.
Chiari malformation patients usually benefit from surgery. Surgery of spinal cord cavitation is of great benefit for one third of patients, and is of partial benefit for another third of patients. The final third of patients do not gain notable benefit from surgery.
Various types of spinal cord cavities and Chiari malformations have been operated at the HUCH Neurosurgery Clinic at a rate of about twenty a year.