• Jacques Lara-Reyna, John Chae, Umberto Tosi, Mark M Souweidane, Rafael Uribe-Cardenas, and Jeffrey P Greenfield.
• Department of Neurological Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, New York.
• Neurosurgery. 2020 Dec 15; 88 (1): E60-E66.

BackgroundThe pathophysiological connection between Chiari malformation and syringomyelia is accepted. Debate remains, however, how can we best define changes in syringomyelia following surgery.ObjectiveTo introduce a grading system focusing on syrinx reduction based on routinely and reproducible radiological information, and provide a suggestion of the application of this scale for prediction of patient's prognoses.MethodsData from 48 patients with Chiari malformation and syringomyelia were compiled. We calculated syrinx cross-sectional area by approximating an ellipse in the largest axial plane. We compared the percentage of reduction or enlargement following surgery. The percentage change was grouped into four grades: Grade 0 = Increasing size, grade I ≤ 50% reduction, grade II = 50% to 90% reduction, grade III ≥ 90% reduction.ResultsA total of 89.6% of patients had syrinx improvement after surgery. A total of 5 patients were grade 0, 14 were grade I, 20 patients were grade II, and 9 patients met criteria for grade III. The mean postoperative syrinx area was 24.1 mm2 (0-169 mm2) with a mean syrinx reduction of 62.7%.ConclusionRadiological improvement of syringomyelia can be mathematically defined and standardized to assist in communication in outcome-based trials. Radiological resolution is expected most patients.Copyright © 2020 by the Congress of Neurological Surgeons.

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