Day 2 of the international SYRINGOMYELIA 2013 meeting in Sydney continued a “deep dive” into Chiari & syringomyelia. As in Day 1, the presentations were grouped into four sessions:

Pathophysiology II
This session opened with a presentation of a computer model of syringomyelia designed to study the biomechanical factors leading to syrinx progression. Another presenter approached the issue from a different perspective - a biochemical one – and reviewed the possible role of aquaporin-4 in syrinx expansion. The possible role of vascular dynamics on the pathogenesis of syringomyelia was also presented.

Surgery for Syringomyelia
The session began with a debate on the treatment of primary syringomyelia: “To shunt or not to shunt.” While each of the two debaters was to defend an opposing point of view, the difference in their recommendations was minimal and both preferred treatment of the offending pathology (CSF flow obstruction) and recommended reserving syrinx-to-subarachnoid stenting for selected cases such as those with dense arachnoiditis in which the CSF flow cannot be safely reestablished.

Additional presentations included a description of a short segment occipital-cervical fusion for the management of symptomatic basilar invagination in patients with CM-I while another participant reviewed preliminary findings on the value of intraoperative neurophysiological monitoring in posterior fossa decompression. Among the surgical videos presented, the use of thecaloscopy using a flexible endoscope provided a journey into the spinal canal rarely visualized. The session ended with a presentation on a minimally invasive technique for Chiari decompression.

Pathophysiology III
The session opened with a fascinating review of the recognition and current understanding of hindbrain herniation and syringomyelia in Cavalier King Charles Spaniels. Subsequent presentations addressed the varying engineering models currently under study for syringomylia, CSF fluid dynamics in syringomyelia, and the possible role of cord pulsations in syrinx development.

Other Causes of Syringomyelia
The session included discussions on the relationship of tethered cord and syringomyelia, on the management of congenital occlusion of the foramen of Magendie, and on the size of the jugular foramen in patients with CM-I.

At this stage, I find the conference stimulating and well as challenging. The more we learn, the more there is to learn. Thankfully, due to the efforts of the organizers and participants, this vibrant international meeting is maturing into an important gathering for professionals caring for persons with Chiari malformation, syringomyelia, and related disorders.

John Oró, MD