What are the available treatment options for syringomyelia?

Treatment options for syringomyelia depend on the severity of symptoms and their progression. In asymptomatic cases, doctors may recommend close monitoring without treatment, especially if the patient is older or if symptoms do not worsen over time. In symptomatic or progressive cases, surgery is the primary option, aimed at restoring the normal flow of cerebrospinal fluid (CSF) around the spinal cord or directly draining the syrinx (cyst).

Syringomyelia Monitoring

If syringomyelia does not cause symptoms, it is typically not treated directly. However, it should be carefully monitored by a neurologist or neurosurgeon, as symptoms can worsen over time. Individuals with syringomyelia are advised to avoid strenuous activities, such as heavy lifting or jumping, as these actions may trigger or exacerbate symptoms. If the syringomyelia is related to a Chiari malformation, the person may experience headaches during exertion [2].

Surgical Intervention

The primary goal of syringomyelia surgery is to eliminate the cyst and prevent further damage to the spinal cord. Surgery is generally recommended for symptomatic or progressively worsening cases. There are two main surgical approaches: restoring the normal flow of cerebrospinal fluid around the spinal cord, or directly draining the cyst. The type of treatment depends on the underlying cause of the symptoms [2].

Specific Surgical Options

• Treating Chiari Malformation: If syringomyelia is caused by a Chiari malformation, the goal of surgery is to create more space at the base of the skull and the upper neck. This reduces pressure on the brain and spinal cord, restoring the normal flow of cerebrospinal fluid. Surgery may allow the cyst to drain, and its size may shrink or disappear completely. Symptoms can improve even if the cyst size remains the same or shrinks only slightly. It is best to seek treatment early if symptoms appear, as delays may lead to permanent spinal cord damage [2].

• Removing Obstructions: Surgical removal of obstructions, such as scar tissue, bone from the spinal canal, or tumors, can help restore normal cerebrospinal fluid flow. If a tumor is the cause of the syringomyelia, its removal often eliminates the cyst. Sometimes, doctors may use radiation therapy to shrink the tumor [2].

• Draining the Cyst: If there is no associated Chiari malformation or tumor, draining the cyst may be necessary. This is typically done in cases where the cyst is growing or the cause of the cerebrospinal fluid obstruction cannot be determined. The surgeon inserts a drainage tube called a shunt to allow the fluid to flow to another part of the body where it can be absorbed. Draining the cyst can stop the progression of symptoms and relieve headaches [2].

Recovery and Follow-up

After surgery, some patients may require additional procedures if the syringomyelia recurs [2]. Magnetic resonance imaging (MRI) scans are the most reliable method for diagnosing syringomyelia and monitoring the effectiveness of treatment, as X-rays are not used [1]. It is important to discuss any questions or concerns with your healthcare provider [1]. You can find more information about syringomyelia by visiting Syringomyelia: Understanding Symptoms and Management (Arabic).

Medical references

• Syringomyelia
• Lumbar MRI scan