Editing Syringomyelia (section)

== Treatment ==

===Surgery===
Treating syringomyelia sometimes requires [[surgery]]. Surgery involving the spinal cord carries certain risks, and as with any medical treatment, the potential benefits have to be weighed against the possible complications. On the other hand, delaying treatment can increase the risk of permanent damage. Evaluation of the condition is necessary because syringomyelia can remain stationary for long periods of time, and in some cases progress rapidly.<ref>{{cite web |title=Chiari malformation |url=https://www.nhs.uk/conditions/chiari-malformation/ |website=NHS UK |date=18 October 2017 }}</ref>

The main goal of surgical intervention is to correct the condition which led to the formation of the syrinx. Draining the syrinx can also help, by preventing it from becoming worse, but the symptoms the syrinx has already caused may not go away.{{citation needed|date=December 2020}}

In cases involving an [[Arnold–Chiari malformation]], the main goal of surgery is to provide more space for the [[cerebellum]] at the base of the skull and upper [[Neck#Anatomy of the human neck|cervical spine]], without entering the brain or spinal cord. This often causes the syrinx to shrink or disappear over time, as the normal flow of [[cerebrospinal fluid]] is restored. If syringomyelia is caused by a [[tumor]], removing the tumor – if possible – is the treatment of choice.<ref>{{cite web |title=Chiari Malformations |url=https://www.ninds.nih.gov/health-information/disorders/chiari-malformations |website=National Institute of Neurological Disorders and Stroke }}</ref>

Most patients’ symptoms stabilize or have a modest improvement following surgery. Syringomyelia can come back, however, requiring additional surgeries which may be less effective.<ref>{{Cite journal |last1=Attenello |first1=Frank J. |last2=McGirt |first2=Matthew J. |last3=Gathinji |first3=Muraya |last4=Datoo |first4=Ghazala |last5=Atiba |first5=April |last6=Weingart |first6=Jon |last7=Carson |first7=Benjamin |last8=Jallo |first8=George I. |date=2008 |title=Outcome of Chiari-associated syringomyelia after hindbrain decompression in children: analysis of 49 consecutive cases |journal=Neurosurgery |volume=62 |issue=6 |pages=1307–1313; discussion 1313 |doi=10.1227/01.neu.0000333302.72307.3b |pmid=18824997 }}</ref>

In some cases, including both communicating and non-communicating forms of the condition, a syrinx may require ongoing drainage. This is done with a [[Shunt (medical)|shunt]], which uses tubes and valves to let [[cerebrospinal fluid]] (CSF) drain from the syrinx into another cavity within the body (usually the abdomen). This type of shunt, called a ventriculoperitoneal shunt, is particularly useful in cases involving [[hydrocephalus]]. By continually draining the syrinx, a shunt can arrest the progression of symptoms and relieve pain, headache, and tightness.<ref>{{Cite journal |last1=Williams |first1=B. |last2=Sgouros |first2=S. |last3=Nenji |first3=E. |date=1995 |title=Cerebrospinal fluid drainage for syringomyelia |journal=European Journal of Pediatric Surgery |volume=5 |issue=Suppl 1 |pages=27–30 |doi=10.1055/s-2008-1066259 |pmid=8770575 }}</ref>

Many factors affect the decision to use a shunt. There are risks of injury to the spinal cord, infection, drainage becoming blocked, and bleeding, and they do not always achieve the intended results. Draining the fluid more quickly does not produce better outcomes, but for some syrinxes, a shunt is the only drainage option.<ref>{{Cite web |date=2018-10-03 |title=Hydrocephalus - Complications |url=https://www.nhs.uk/conditions/hydrocephalus/complications/ |access-date=2022-11-14 |website=nhs.uk |language=en}}</ref>

In the case of trauma-related syringomyelia, the surgeon operates at the level of the initial injury. The syrinx collapses at surgery, but a tube or shunt is usually necessary to prevent it from returning.<ref>{{Cite journal |last1=Byun |first1=Min Seok |last2=Shin |first2=Jun Jae |last3=Hwang |first3=Yong Soon |last4=Park |first4=Sang Keun |date=2010 |title=Decompressive Surgery in a Patient with Posttraumatic Syringomyelia |journal=Journal of Korean Neurosurgical Society |volume=47 |issue=3 |pages=228–231 |doi=10.3340/jkns.2010.47.3.228 |pmc=2851081 |pmid=20379479 }}</ref>

===Non-surgical interventions===
Surgery is not always recommended for syringomyelia patients. While there is no medication which can cure the condition, for many patients, the main treatment is [[analgesia]] to manage the symptoms. Physicians specializing in pain management can develop a medication and treatment plan to ameliorate pain. Medications to combat any neuropathic pain symptoms such as shooting and stabbing pains (e.g. [[gabapentin]] or [[pregabalin]]) would be first-line choices. Opiates are usually prescribed for pain for management of this condition. Conversely, [[facet joint injections]] are not indicated for the treatment of syringomyelia.<ref>{{Citation |last1=Schug |first1=Stephan A. |title=Treatment of Neuropathic Pain |date=2011 |url=http://www.ncbi.nlm.nih.gov/books/NBK534257/ |work=Mechanisms of Vascular Disease: A Reference Book for Vascular Specialists |editor-last=Fitridge |editor-first=Robert |place=Adelaide (AU) |publisher=University of Adelaide Press |isbn=978-0-9871718-2-5 |pmid=30485013 |access-date=2022-11-14 |last2=Stannard |first2=Kathryn JD |editor2-last=Thompson |editor2-first=Matthew}}</ref>

[[Radiation]] is rare, but may be used if a tumor is involved. In these cases, it can halt the extension of a cavity and may help to alleviate pain.<ref>{{cite book |title=Syringomyelia |date=January 1994 |publisher=U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health |location=University of California Riverside |pages=4 |url=https://books.google.com/books?id=5Y_oUJDUHtcC&dq=Drugs+have+no+curative+value+as+a+treatment+for+syringomyelia.+Radiation+is+used+rarely,+and+is+of+little+benefit+except+in+the+presence+of+a+tumor.+In+these+cases,+it+can+halt+the+extension+of+a+cavity+and+may+help+to+alleviate+pain&pg=PP6 |access-date=April 19, 2022}}</ref>

Treatment is usually reserved for cases which are causing symptoms. Treatment may not provide enough benefits to be recommended for elderly patients, or when symptoms are stable instead of worsening. Whether treated or not, many patients are advised to avoid activities that involve straining.<ref name="NINDS Syringomyelia">{{cite web |title=Syringomyelia |url=https://www.ninds.nih.gov/health-information/disorders/syringomyelia |website=National Institute of Neurological Disorders and Stroke }}</ref>

A conservative approach may be recommended, as the natural history of syringomyelia is not yet well understood. When surgery is not currently advised, patients are monitored with regular physical evaluations and MRI's.<ref>{{Cite journal |last1=Kanga |first1=Ismat |last2=Wong |first2=Jessica J. |last3=Stern |first3=Paula J. |date=2014 |title=Detection of syringomyelia in a pediatric patient with mild scoliosis: a case report |journal=The Journal of the Canadian Chiropractic Association |volume=58 |issue=1 |pages=16–23 |pmc=3924508 |pmid=24587493 }}</ref>