Syringomyelia has fascinated neurologists and neurosurgeons for decades, if not for centuries. The slowly progressing cystic cavitations of the spinal cord have led scientists and clinicians to various pathophysiological hypotheses and treatment strategies. Until recently, no clear concept existed as to what caused a syrinx and how and when a particular patient should be treated. The introduction of magnetic resonance imaging (MRI) has revolutionized our view of syringomyelia. For the first time, we are able to diagnose a syrinx before it produces clinical symptoms, and we can follow the course of the syrinx before and after surgical treatment with a noninvasive method. This has led to a huge amount of information not available to previous scientists. Nevertheless, pathophysiology and treatment are still contro versial. The aim of this book is to give a guideline on how to approach a patient with a syrinx. Based on clinical experience, we have modified our strategies repeatedly in an attempt to improve clinical results. We have developed a treatment concept, evolved out of 20 years of clinical and experimental work, which has proven to be a solid basis for our decision making. Clinical courses, surgical indications, tech niques, and postoperative results are discussed for each of the different pathologies known to be associated with syringomyelia. In this manner, we hope to give a co herent overview on all aspects of syringomyelia, which should help physicians to counsel and treat patients with this fascinating but also potentially devastating dis ease.
Magnetic resonance imaging (MRI) has revolutionized our understanding of many neurological diseases. This is the first textbook on syringomyelia by a single team of authors since the introduction of this imaging modality. Based on a pathophysiological concept which is presented in the opening chapters of this book, we provide guidelines for diagnosis and surgical treatment of patients with syringomyelia. Syringomyelia is a manifestation of cerebrospinal fluid (CSF) flow obstruction, spinal cord tethering, or a spinal cord tumor. Therefore, an underlying pathology characterized by at least one of these features can be identified for every patient. Each entity which may lead to syringomyelia is described in a separate chapter, covering clincial presentations, neuroradiological features, neurophysiology, surgical indications and techniques and a detailed analysis of postoperative results. Special sections are devoted to patients in whom surgical treatment failed initially.This book should help any physician dealing with a patient with syringomyelia to initiate the appropriate diagnostic test and studies to identify the underlying disorder. Based on the analyses of postoperative outcomes for each of these disorders, the patient may be advised to either undergo surgery or to continue conservative treatment. Neurosurgeons are given precise guidelines for surgical indications and strategies. Microsurgical techniques are illustrated step by step and include detailed intraoperative photographs.
