title: Syringomyelia and tethered cord in children.
abstract: BACKGROUND
  The presence of syringomyelia varies in patients with different forms of dysraphism; from 21 % to 67 %. Only around 60 % of patients with syringomyelia is likely to experience symptoms related to it.
  
  
  METHODS
  Many theories have been outlined for the creation of syringomyelia. The one most applicable to tethered cord dictates that tensile radial stress may create a syrinx in a previously normal cord tissue and transiently lower pressure may draw in interstitial fluid, causing the syrinx to enlarge if fluid exit is inhibited. In addition, arachnoiditis increases flow resistance in the spinal subarachnoid space, altering temporal CSF pulse pressure dynamics, which promotes entry of CSF in to the spinal cord.
  
  
  METHODS
  There is a significant overlap between the symptoms that are due to tethered cord and syringomyelia, both in newly presenting patients with coexisting syringomyelia, and in previously treated patients who during follow-up present recurrent symptoms and a new syringomyelia cavity.
  
  
  METHODS
  The treatment of patients with tethered cord and syringomyelia is directed towards untethering the cord from its most caudal region upwards and restoring spinal anatomy with reestablishment of unobstructed CSF flow in the subarachnoid space. Only if complete untethering has been ensured and syringomyelia deteriorates, then surgical treatment can be directed against the syrinx. In patients with spinal dysraphism and coexisting hydrocephalus, radiological presentation of new syringomyelia or deterioration of previously known syringomyelia may signify shunt obstruction "until proven otherwise".
  
  
  CONCLUSIONS
  In most occasions, satisfactory cord untethering addresses the development of syringomyelia.
authors.affiliation: "Mitera" Childrens Hospital, Erythrou Stavrou 6 Marousi, 151 23 Athens, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Tsitouras
authors.forename: Spyros
authors.initials: S
authors.lastname: Sgouros
mesh_terms: D002648:Child; D006801:Humans; D009436:Neural Tube Defects / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D019635:Neurosurgical Procedures; D013116:Spinal Cord / Q000196:embryology; D013595:Syringomyelia / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery