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REVIEW ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 3  |  Page : 120-127

Concepts in the Management of Syringomyelia


1 Assistant Professor, Department of Neurosurgery, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
2 Senior Resident, Department of Neurosurgery, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
3 Professor and Head, Department of Neurosurgery, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India

Correspondence Address:
Abhidha Shah
Assistant Professor, Department of Neurosurgery, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.5005/jp-journals-10039-1184

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Objective: The authors analyze their experience with syringomyelia. The treatment was focused on identification of the primary etiological factor and its treatment. Methods: Depending on the etiological factors and treatment considerations the series was classified into three groups. Group 1 had cases where there was no definite demonstrable etiological factor. Group 2 cases had basilar invagination and/or Chiari malformation, and Group 3 consisted of cases where the syrinx was secondary to an obvious aetiology, such as a mass lesion either in the posterior cranial fossa or in the spine or a severe kyphotic spinal deformity. Post-traumatic syringomyelia and syrinx in association with spina bifida were not studied. There is a significant subgroup where no cause is identified when evaluated by conventional radiological parameters. However, atlantoaxial dislocation was identified when assessed by Goel classification of facetal alignment. Results: In general, in Group 1 (or in idiopathic group), atlantoaxial instability was identified and was accordingly treated. In Group II, atlantoaxial instability was considered to be defining phenomenon. Accordingly atlantoaxial fixation was the treatment. In Group III the treatment was focused on the etiological factor. It was identified that direct syrinx drainage was not only not useful, but was harmful. It was observed that clinical outcome rather than radiological improvement is the reliable indicator of the surgical result. Conclusion: Syringomyelia is ‘never’ a primary pathological event but is secondary to a known or unknown (or unidentified) pathology. Treatment of the primary etiology is the goal in management of this condition


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