Syringomyelia is a condition characterized by the formation of a fluid-filled cyst, known as a syrinx, within the spinal cord. As this syrinx expands, it can damage nerve fibers, leading to symptoms like pain, weakness, and loss of sensation. The primary objective of surgery is to halt the progression of this damage. Surgical intervention can also alleviate existing symptoms by addressing the syrinx’s root cause or by draining the fluid.
When Surgery Is Recommended
The decision to proceed with surgery for syringomyelia is based on an individualized assessment. Neurosurgeons often adopt a “watchful waiting” approach if a person has no or only mild symptoms, monitoring the condition with periodic magnetic resonance imaging (MRI) scans. A surgical consultation becomes more likely when symptoms progress and impact daily life.
Key factors influencing the decision include worsening neurological symptoms such as increasing pain, progressive muscle weakness, or expanding areas of numbness. The size and rate of growth of the syrinx as observed on sequential MRI scans are also significant considerations. If the syrinx is enlarging, it suggests an ongoing process that may cause further spinal cord damage.
The presence of an identifiable and correctable underlying cause is another strong indicator for surgery. The choice to operate is made by weighing the risks of surgery against the risks of progressive neurological decline.
Types of Surgical Procedures
Surgical treatments for syringomyelia are categorized into two main approaches. The first aims to correct the underlying problem causing the syrinx, while the second involves draining the syrinx directly. The choice of procedure depends on the specific cause of the syringomyelia, the patient’s anatomy, and their overall health.
The most common cause of syringomyelia is a Chiari I malformation, and the standard treatment is a posterior fossa decompression. This procedure involves removing a small section of bone from the back of the skull to create more space for the cerebellum and brainstem. This enlargement helps restore the normal flow of cerebrospinal fluid (CSF), which can lead to the syrinx’s collapse. A patch is often sewn into the dura mater, the covering of the brain and spinal cord, to further expand the area.
When the underlying cause cannot be fixed, or if decompression surgery is unsuccessful, a procedure to directly drain the syrinx may be performed. This involves placing a shunt, which is a small, flexible tube, into the syrinx cavity. The shunt channels fluid away from the spinal cord to another part of the body for absorption, such as the space around the spinal cord or the chest cavity. Shunts can reduce the syrinx size but carry risks like blockages or infection, which may require additional surgery.
The Hospital Stay and Procedure
The surgical experience begins with admission to the hospital, usually on the day of or the day before the operation. Pre-operative preparations involve a final review of MRI scans, blood tests, and a meeting with the anesthesiologist. Patients will be instructed to not eat or drink for a specific period before the surgery.
Once under general anesthesia, the surgical team positions the patient, typically lying face down for posterior fossa decompression. The surgery itself can last for several hours. After the procedure is complete, the patient is moved to a recovery area or a neuro-intensive care unit (ICU) for close monitoring.
Medical staff will manage post-operative pain with medication and watch for any immediate complications. The hospital stay ranges from a few days to over a week. During this time, the focus is on pain control, wound care, and gradually increasing mobility before being discharged.
Post-Surgical Recovery and Prognosis
Post-hospital recovery is a gradual process. Patients are given restrictions on activities, such as avoiding heavy lifting and strenuous exercise for an initial period to allow the surgical site to heal properly. Follow-up appointments with the neurosurgeon are scheduled to monitor progress and the healing of the incision.
Physical and occupational therapy often play a part in the recovery journey. Therapists work with patients to help regain strength, improve balance, and find ways to manage any persistent neurological symptoms. Regular MRI scans are also a component of long-term follow-up to check that the syrinx has decreased in size or at least stabilized.
The outlook following surgery varies among individuals. The primary goal of the operation is to stop the progression of spinal cord damage, and many patients experience a stabilization of their symptoms. While some see a significant improvement, a complete resolution of all symptoms is less common if substantial nerve damage existed before surgery. A syrinx that shrinks without disappearing entirely is still considered a successful outcome because it halts further injury to the spinal cord.