Treating Non-Communicating Syringomyelia
If a tumor is causing
syringomyelia, removal of the tumor is the treatment of choice, and this is usually successful in eliminating the syrinx.
In the case of trauma-related syringomyelia, the surgeon operates at the level of the initial injury. Until the 1990s, the most common approach was to collapse the cyst in surgery and then insert a tube, or shunt, to prevent its re-expansion. Because shunts routinely become clogged and require multiple operations, however, many surgeons now consider this option only as a last resort.
Instead, surgeons now expand the space around the spinal cord by realigning the vertebrae, or discs, that are narrowing the spinal column. They then add a patch to expand the "dura" -- the membrane that surrounds the spinal cord and contains the cerebrospinal fluid (CSF) -- a procedure called "expansive duraplasty." It is also considered important to remove scar tissue attached to the membranes that "tether" the cord in place and prevent the free flow of CSF around it.
Many individuals with spinal cord injuries have a cyst at the site of their original injury. These cysts do not always require syringomyelia treatment, although if they grow larger or begin to cause symptoms, treatment may be recommended.
Syringomyelia Treatment: Shunt Placement
In some patients, it may be necessary to drain the syrinx, which can be accomplished using a catheter, drainage tubes, and valves. This system is known as a shunt. Shunts are used in both the communicating and non-communicating forms of the disorder. (Doctors will also use a shunt for
normal pressure hydrocephalus.)
First, the surgeon must locate the syrinx. Then, the shunt is placed into it, with the other end draining the syrinx fluid into a cavity, usually the abdomen. This type of shunt is called a syringoperitoneal shunt. A shunt of CSF from the brain to the abdomen is called a ventriculoperitoneal shunt, and is used in cases involving
hydrocephalus. By draining syrinx fluid or CSF, a shunt can arrest the progression of symptoms and relieve pain,
headache, and tightness. Without correction, symptoms generally continue.
The decision to use a shunt requires extensive discussion between doctor and patient, as this procedure carries with it the risk of injury to the spinal cord, infection, blockage, or hemorrhage, and may not necessarily work for all patients.
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