Conditions - Q & A with Dr. Benzel

by Dr.Edward Benzel. A neurosurgeon and Director of Spinal Disorders at the Cleveland Clinic in Ohio, and member of ASAP’s Medical Advisory Board.

I suffer from a lot of pain caused by a moderate-sized syrinx and Chiari. I am scheduled to have a decompression. What are the chances of the pain improving after the surgery?

Since many patients have pain that is unrelated to the syrinx and a chiari malformation, the chances of the pain improving following surgery are not 100%. There are many factors that play a role in this process. One should be very careful to not be excessively optimistic regarding the relief of all symptoms following chiari malformation or syringomyelia surgery. It, however, is reasonable to expect at least a 50-60% chance of pain reduction following the operation. This obviously must take into consideration the nature of the pain, which is difficult to understand without personal one on one communication between the physician and the patient.

What is a dura leak, how do I know if I have one and what should be done about it?

The leakage of spinal fluid through the covering over the brain and spinal cord called the dura mater (dura). This covering is generally very tough. However, following surgery, such as surgery for a chiari malformation, leakage of spinal fluid through the dura mater (dura) may occur. It may be obvious because it leaks into the soft tissues around the surgical site through the skin. This drainage is evident. It unfortunately may lead to infection and other complications that therefore should be surgically treated.

A dural leak could also occur but not extend up to the level of the skin. This type of leak may not be as evident. A bulge under the surface of the skin may be the only physical sign. People with such leaks may complain of headache, particularly while upright.