Anterior Spinal Cord Fissuring: A Predictor of Spontaneous Resolution of Syrinx?

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/impression, 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 sudden rapid deterioration. At present, there is a general consensus to offer surgical decompression in all patients diagnosed with Chiari I malformation with syrinx irrespective of their symptoms in order to prevent delayed neurological worsening. Few authors have reported 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 decompression of Chiari malformation.