Anterior spinal cord fissuring: A predictor of spontaneous resolution of syrinx?

Abstract

Syringomyelia is a disorder of the spinal cord usually seen in association with a variety of craniovertebral junction anomalies (e.g., Chiari malformations, basilar invagination/im-pression, atlantoaxial instability, etc.). Its natural history is not very clearly understood and a majority of patients present with a slowly progressive neurological deficit followed by sud-den rapid deterioration. At present, there is a general consensus to offer surgical decom-pression in all patients diagnosed with Chiari I malformation with syrinx irrespective of their symptoms in order to prevent delayed neurological worsening. Few authors have re-ported spontaneous resolution of syrinx with persistent tonsillar herniation without operative treatment. We report one such patient and propose anterior spinal cord fissuring as a plausible cause of spontaneous syrinx drainage. We also propose conservative management for patients with an anterior spinal cord fissure seen in index scans instead of early decom-pression of Chiari malformation.