[Music] ceringomyelia is another late sequel of spinal cord injury patients with post traumatic syringomyelia usually present with pain but motor deficits and sensory loss can also be common and there's a classic sort of dissociated sensory loss which is loss of pain and temperature the preservation of light touch that reflects intact dorsal columns and that's considered to be characteristic of a serins and more common than a complete sensory loss where there's just a sensory level of all modalities and motor symptoms may reflect injury to the the lateral cortical spinal tract and there are other less common symptoms that can include hyperhidrosis autonomic dysreflexia horner's syndrome respiratory issues if you're going up into the cervical spine or even cranial nerve involvement if you're going up into the medulla you can see here this person has most likely a high thoracic cord injury and you can see this hearing is going all the way up um almost into the into the brain stem you can see here as well now sometimes these can be surgical um the goal of surgical treatment for for a post-traumatic syringe should be disease stabilization but importantly that doesn't always mean an improvement in neurologic function or pain it just means preventing it from getting worse we hope there are a couple different ways to deal with these those include simple spinal decompressions percutaneous drainage serum shunting lysis of adhesions expansion duroplasties and core detethering but it's important to recognize that these all have kind of a limited utility um and so you need to really carefully uh balance the morbidity of surgery with the potential benefits because these surgeries are not all that satisfying and and often um the symptoms will recur now shunting um in a post-traumatic series will either be um include taking that fluid and putting it into the subarachnoid space which is a cyringo subarachnoid shunt or into some other low pressure cavity like the pleural cavity or the peritoneal cavity um and that can be effective but again there's generally re-scarring of the arachnoid and so that has limited durability and so again you want to carefully consider that and so um the way i can sort of demonstrate that is this isn't just a searing problem you can see here this this fluid inside the spinal cord you can also see there's sort of anterior tethering and so that indicates that there's some csf hydrodynamic changes here that we don't completely understand but we do know that it's not necessarily as simple as just you know draining it into another space but um since syringosubarachoid chanting is pretty rare it's an interesting procedure and it's kind of hard to conceptualize if you can't see a picture of it so i've included this diagram to kind of explain the procedure so this is a view of the cervical spine where um a laminectomy has been done this is the dura um and you can see they've opened the dura here and what they're doing with this scalpel is they're actually opening the spinal cord and so they're opening the spinal cord into the searing cavity and then they insert this little long shunt okay it's a tiny silastic tube sometimes it's a t-tube shape so it's shaped like this and you put the the top part of the tea inside the spinal cord and the other part sort of sticks out and what that's supposed to do is is sort of make this space communicating so the fluid inside the spinal cord can get out of the spinal cord then you sew everything back up that can work it tends to have maybe less enthusiasm now than it did when it was first sort of invented because we know that those things kind of scar down might work for a little bit and then and then you're back where you started um shortly thereafter so not necessarily the the great procedure that we maybe hoped it was when it was first first sort of invented hey everyone ryan rad here from neurosurgery training.org if you like that video subscribe and donate to keep our content available for medical students across the world