Classification of Syringomyelia

       Classification of syringomyelia is still under debate, since the onset of the syrinx underlying pathogenesis is still under development and debate the experts.
Basically classification systems seen from:

1. Age: children, adults
2. Anatomy of the spinal cord: cranio cervical junction, spinal cord
3. Pathogenesis: congenital, acquired
4. The underlying pathology: non-neoplastic, neoplastic, post-traumatic, post-inflammatory
5. Relationship with central canal: hydromyelia, syringomyelia
6. Relationship with ventricular IV: communicating,
7. Fluid in the cavity such as cerebrospinal fluid, high in protein .
8. The configuration of the cavity: insulated, unicameral.


      From these criteria it appears that syringomyelia is not a stand-alone disorder, but rather a pathological condition with diverse causes. This gives rise to the cause of diverse clinical picture anyway .

        Some centers embrace syringomyelia based MRI classification proposed by Milhorat.
 

Classification of syringomyelia :
 

I. Communicating syringomyelia :
   A. Central canal dilatations .
        1. communicating hydrocephalus (posthemorrhage postmeningitic)
        2. Complex hindbrain malformation (Chiary II, encephalocele)
        3. Dandy - Walker cyst .

II . Noncommunicating syringomyelia:
     A. Central canal / paracantral syringes
        1. Chiary malformation.
        2. Basilar invagination.
        3. Spinal arachnoiditis (posttraumatic, postmeningitic)
        4. Extramedullary compressions (sponylosis, tumors)
        5. Tethered cord.
        6. Acquired tonsillar herniation (hydrocephalus, intracranial mass lesions)
     B. Primary parenchymal cavitations :
        1. Spinal cord trauma .
        2. Ischema / infaction .
        3. Intramedullary hemorrhage .

III. Atrophic cavitations (syringomyelia ex vacuo)
IV. Neoplastic cavitations


Classification of syringomyelia according to Barnett et al :
 

Type I. Syringomyelia with foramen magnum obstruction and dilatation of the central canal (type developmental)
A. With Chiari malformation type I
B. With other obstruction lesions on oramen magnum

Type II. Syringomyelia without obstruction at the foramen magnum (idiopathic type developmental)

Type III. Syringomyelia with other diseases in the spinal cord (acquired type)
A. Spinal cord tumor (usually intramedullary, particularly hemangioblastoma)
B. Traumatic myelopathy
C. Spinal arachnoiditis and pachymeningitis
D. Secondary myelomalacia of spinal compression (tumor, spondylosis), infarction, hydromyelia


Type IV. Pure hydromyelia (development dilatation of the central canal), with or without hydrocephalus