Management of syringomyelia associated with chiari malformation: Comparative study of syrinx size and symptoms by magnetic resonance imaging

The authors reviewed the postoperative alteration of symptoms and syrinx size by magnetic resonance imaging (MRI) in 14 consecutive patients with syringomyelia associated with Chiari malformation. The patients were treated according to our treatment regimen and were divided into five groups according to operative modalities: (1) only foramen magnum decompression (D) for small syrinx; (2) D with ventriculoperitoneal (VP) shunt for small syrinx with hydrocephalus; (3) D with syringosubarachnoid (SS) shunt or (4) D with syringoperitoneal (SP) shunt for large syrinx; and (5) only VP shunt for syrinx with hydrocephalus and atlantoaxial dislocation, respectively. From the preoperative and postoperative sagittal MR images, the areas of the spinal cord and syrinx were measured by a digitizer and the syringo-cord (S-C) ratio was calculated. Out of 14 patients, 12 showed a reduction of syrinx size and a stabilization or improvement of symptoms after surgery. In the other two patients, the syrinx size did not change and their symptoms worsened. Magnetic resonance imaging follow-up showed that foramen magnum decompression without shunt is effective for patients with a small syrinx below 35% of the S-C ratio, and foramen magnum decompression with shunt was effective for patients with a large syrinx over 35% of the S-C ratio, but there was no significant difference between the SS and SP shunt group.