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PubMed This is a summary of 22 peer-reviewed journal articles Updated
Neurology

Treating the Cause: Surgical and Conservative Options

At a Glance

The primary goal of treating syringomyelia is to address the underlying cause of the blocked fluid rather than just draining the syrinx. Treatment ranges from careful observation for asymptomatic patients to decompression or untethering surgeries for those with worsening symptoms.

Deciding how to manage syringomyelia is a highly individualized process. Because every patient’s “plumbing” is different, doctors use a decision tree to determine whether a “watch and wait” approach or surgical intervention is the most appropriate path forward.

Conservative Management: “Watch and Wait”

If your syrinx was found “by accident” (incidentally) and you are not experiencing any neurological symptoms, your doctor may recommend conservative management [1][2].

  • When it’s appropriate: This approach is common for patients who are asymptomatic, meaning they have no pain, weakness, or sensory loss [1].
  • The Surveillance Plan: You will typically undergo regular neurological exams and serial MRI scans (often every 6–12 months initially) to ensure the syrinx is not growing and that no new symptoms are developing [3][2].
  • Stability: Many people remain stable for decades under observation without ever needing surgery [2].

The Goal of Surgery: Fixing the “Plumbing”

When surgery is necessary—usually due to worsening symptoms or a rapidly growing syrinx—the standard of care is to treat the underlying cause rather than just “draining” the syrinx itself [4][5].

1. Posterior Fossa Decompression (PFD)

This is the most common surgery for syringomyelia caused by a Chiari I Malformation. The goal is to create more space at the base of the skull so fluid (CSF) can flow freely [4][6].

  • Bone-Only Decompression: The surgeon removes a small piece of the skull at the back of the head [7].
  • Duraplasty: Often, the surgeon will also open the dura (the tough lining around the brain) and sew in a patch to further expand the space [6][7]. While this carries a slightly higher risk of fluid leaks, it is often more effective at shrinking the syrinx in the long term [6][8].

2. Spinal Cord Untethering

If the syrinx is caused by Tethered Cord Syndrome, the surgeon will perform an untethering procedure [9]. By releasing the “stuck” part of the spinal cord, the mechanical tension is relieved, which often allows the syrinx to stabilize or resolve on its own [5][10].

3. Addressing Scars or Tumors

For post-traumatic or post-infectious cases, the surgeon may perform arachnoidolysis—carefully removing scar tissue to restore fluid flow [11]. If a tumor is the cause, removing the tumor is the primary focus [12].

Why Shunts are a “Backup Plan”

In the past, doctors often placed a shunt (a small tube) directly into the syrinx to drain the fluid into another part of the body, like the abdomen (syringo-peritoneal shunt) or the space around the cord (syringo-subarachnoid shunt) [13][14].

Today, shunts are generally considered a secondary or backup option [15][13]. This is because:

  • They don’t fix the cause: A shunt drains the fluid but doesn’t fix the “clogged pipe” that caused the syrinx in the first place [16].
  • Complication Risks: Shunts can become blocked, migrate, or cause infections, often requiring multiple “revision” surgeries over a lifetime [15][17].
  • Refractory Cases: Shunts are typically reserved for refractory cases—meaning the syrinx didn’t improve after a primary decompression—or for cases where the underlying cause cannot be identified (idiopathic) [13][18].

Measuring Success

The primary goal of surgery is stabilization—stopping the syrinx from getting worse and preventing further nerve damage [19][20]. While many patients experience a reduction in syrinx size and an improvement in symptoms, some neurological damage (like certain types of numbness or muscle wasting) may be permanent even after a “successful” surgery [21][22].

Common questions in this guide

When is 'watch and wait' recommended for syringomyelia?
Conservative management is typically recommended when a syrinx is found incidentally and causes no symptoms. You will undergo regular neurological exams and MRI scans to ensure the syrinx is stable and not growing.
What is the main goal of syringomyelia surgery?
The primary goal of surgery is to treat the underlying cause of the fluid blockage, rather than just draining the syrinx itself. By fixing the root problem, surgeons aim to stabilize the condition and prevent further nerve damage.
What is a posterior fossa decompression (PFD)?
PFD is the most common surgery for a syrinx caused by a Chiari malformation. The surgeon removes a small piece of skull at the back of the head, and sometimes patches the brain lining, to create more space and allow spinal fluid to flow freely.
Why aren't shunts used as the first treatment for a syrinx?
Shunts only drain the fluid but do not fix the underlying blockage that caused the syrinx in the first place. They are generally considered a backup option due to higher risks of blockages, infections, and the potential need for future revision surgeries.
Will surgery reverse my syringomyelia symptoms?
While surgery often reduces the size of the syrinx and can improve symptoms, its main goal is to stop the condition from worsening. Some nerve damage, such as certain types of numbness or muscle wasting, may be permanent even after successful surgery.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Am I a candidate for 'watch and wait,' or does the current state of my syrinx suggest surgery is necessary now?
  2. 2.If we choose surgery, will you be performing a 'bone-only' decompression or a decompression with duraplasty? What are the risks and benefits of each for my specific anatomy?
  3. 3.If the goal is to 'fix the plumbing,' what is the likelihood that my syrinx will shrink or resolve after the primary cause is addressed?
  4. 4.What is your experience and success rate with performing posterior fossa decompression or untethering?
  5. 5.Under what circumstances would you consider a syrinx shunt, and why is that not the first option for me?
  6. 6.What are the 'red flag' neurological changes that should trigger a transition from conservative management to surgical intervention?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (22)
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    Chiari I malformation in children-the natural history.

    Chatrath A, Marino A, Taylor D, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2019; (35(10)):1793-1799 doi:10.1007/s00381-019-04310-0.

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    Long-term outcomes for children with an incidentally discovered Chiari malformation type 1: what is the clinical significance?

    Davidson L, Phan TN, Myseros JS, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2021; (37(4)):1191-1197 doi:10.1007/s00381-020-04980-1.

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    A Conservative Approach to Clinical Management of Syringomyelia.

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    Cureus 2025; (17(11)):e96661 doi:10.7759/cureus.96661.

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    Evaluation and Treatment of Patients with Small Posterior Cranial Fossa and Chiari Malformation, Types 0 and 1.

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    Optimizing Therapeutic Strategies for Syringomyelia Associated with Tethered Cord Syndrome: A Comprehensive Review.

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    Children (Basel, Switzerland) 2024; (11(8)) doi:10.3390/children11080961.

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    Posterior Fossa Decompression Versus Syringo-Subarachnoid Shunt for Chiari I-associated Syringomyelia: A Systematic Review.

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    Posterior Fossa Decompression with or Without Duraplasty for Chiari I Malformation.

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    Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium.

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    Surgical outcomes by sectioning a filum terminale in patients with terminal syringomyelia.

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    Case of Syringomyelia Associated with Ossified Yellow Ligament and Arachnoid Web.

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This page provides general information about syringomyelia treatment options. Always discuss your specific surgical risks and conservative management plan with your neurologist or neurosurgeon.

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