Syringomyelia – Diagnosis and Treatment

J Klekamp and Madjid Samii. Published by Springer-Verlag: Berlin, Heidelberg, New York, 2002. ISNB 3 540 42084 3. £87.00

In this authoritative book on Syringomyelia, the authors present their valuable clinical experience over twenty years in a simplified, well presented and illustrated text. They declare the aim of the book was to give a guideline on how to approach a patient with a syrinx. They have indeed proved successful in achieving their goal.

The book is divided into four chapters, the first two deal with general information and pathophysiology of syringomyelia. The third and fourth chapters, cover aetiological classification into cranial cervical junction and spinal disorders respectively as potential anatomical location where disease processes could lead to the development of syringomyelia.

The book has the advantage that each chapter can be read as a separate section without the need to go to previous ones. The clinical presentation of the variety of disorders is well detailed. Surgical management is also well explained, together with strategies for dealing with the syrinx and also when hydrocephalus is present. Whilst neurophysiological investigations have little role to play in the diagnosis, the section on management emphasises their usefulness for intraoperative monitoring. Post operative outcome and clinical results are detailed in comparison to the pre-operative symptoms and also to the type of operation in exhaustive tables. The rate of complications is also usefully detailed.

In diseases of the spinal canal where usually the Clinician finds it difficult to identify a cause, the authors gave their firm belief that idiopathic syringomyelia does not exist. In each patient they were able to identify a cause. The authors emphasise the importance of diligent search as to the underlying spinal pathology leading to the CSF flow obstruction. When not obvious, clues about where to look can be obtained from a carefully taken clinical history and a study of the shape of the syrinx. In addition to usual MRI imaging techniques, dynamic imaging with phase contrast Cine-MRI can be employed to search for an area of CSF flow obstruction as an indicator of the focal area of arachnoid pathology. Surgical management including strategies for patients with additional degenerative disease, kyphotic angulation or spinal instabilities are described. The book benefits from fully illustrated MRI imaging, photographs of surgical views accompanied by a brief summary of the presenting problem in the individual case, all useful to emphasise the varied manifestation of syringomyelia.

In summary this book would prove invaluable to Trainees, Neurologists and Neurosurgeons and all involved in the management of syringomyelia. At a price of £87.00 it offers supreme value for money.