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The dilemma and burden of incidental and asymptomatic syrinxes – CSF Flow

The dilemma and burden of incidental and asymptomatic syrinxes

Background

Syringomyelia and cord cysts despite frequently being idiopathic and asymptomatic, are a cause of anxiety and cost. No published large clinical series have demonstrated their evolution when managed conservatively.

Aims

  • To assess current UK practice.
  • To review patients seen at the South West Neurosurgical Centre and establish local management and follow up practice.
  • To review radiological and clinical change.

Methods

A follow up practice questionnaire was sent to members of the UK, British Syringomyelia and Chiari Group. Locally, demographic data, contributory pathology, follow up duration, radiological and clinical outcome and MRI parameters were recorded for patients diagnosed with syringomyelia from 2002 to 2017. The cohort was divided according to whether surgery was undertaken.

Results

14% of responding BSCG members do not follow up conservatively managed syrinxes irrespective of appearance.

64% follow up even asymptomatic dilated central canals. Size and loculations were radiological features precipitating follow up imaging.

97 patients at the South West Neurosurgical Centre were reviewed.

67 patients were managed conservatively (32 with an idiopathic syrinx, 22 with a Chiari malformation, 3 with dysraphism, 4 with tumours, 4 with a history of trauma, and 1 post infective).

57% had a craniovertebral decompression.

Follow-up imaging was present for 81 patients. In the conservatively managed cohort syrinx size was unchanged in 82%, reduced in 10% and increased in 8%. We present the common radiological characteristics of the groups. Median follow up duration was 24 months.

Conclusions

Surgeons make decisions on asymptomatic syrinx follow up based on personal experience and perhaps practice defensive medicine. A larger retrospective review and prospective longitudinal study are proposed as a way of attaining predictive information with respect to clinical presentation, precipitant, and radiological appearance which will allow health care providers to suitably advise and monitor patients.