gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The Syrinx Protocol: Preoperative diagnostics and surgical management in arachnopathy-associated syringomyelia

Diagnostik und neurochirurgisches Management bei Arachnopathie-assoziierter Syringomyelie

Meeting Abstract

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  • corresponding author F. Roser - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • M. Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.05.03

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Roser et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Minimal spinal trauma as the cause of syringomyelia is commonly neglected in the management of this potentially disabling disease. However, the restoration of adequate CSF circulation can lead to a cessation of disease progression. We present an optimized preoperative diagnostic protocol for syringomyelia patients in order to detect the underlying pathology.

Methods: Syringomyelia patients undergo a standardized workup including electrophysiological measurements (SEP and MEP) as well as silent-period testing for the detection of alteration in AD-pain fibres. In addition to routine MRI-diagnostics sagittal cardiac-gated sequences (CINE) and sagittal 3D-constructive-interference-in-steady-state (CISS) sequences, were performed. An indication for neurosurgical intervention emerges if a focal adhesion is detected. The operation aims to decompress the subarachnoid space including an enlarging duroplasty.

Results: 57 patients with syringomyelia prospectively underwent the diagnostic protocol. With the expanded electrophysiological workup, a differentiation between hydromyelia (dilated central canal) and syringomyelia with pathologic changes in the crossing spinal cord tracts can be made. The sensitivities/specificities of the silent-periods for several syringomyelia symptoms (e.g. dysaesthesia, pain) are significantly higher than of SEP/MEP recordings. With the specialized MRI-diagnostics 24% more patients could be diagnosed with the syringomyelia-causing pathology: A spinal arachnoid web, cyst or scar had developed through a former spinal trauma. All treated patients showed an immediate collapse of the syrinx, neurological symptoms did improve; however in most cases long-standing neurological deficits remain unchanged.

Conclusions: Syringomyelia should be seen as a symptom of an underlying arachnoid process, most often caused by a minor spinal trauma with scar formation causing CSF flow obstruction. Neurosurgical detection and restoration of adequate CSF flow can stop the progressive course of the disease.