Vol. 22, No.
5 May 2000 V
CE Refereed Peer Review
FOCAL POINT
★Intraspinal cord abnormalities
caused by cyst formation are an
increasingly recognized cause of
spinal cord disease in dogs and
cats.
KEY FACTS
■ Syringomyelia refers to abnormal
cavities filled with fluid in the
spinal cord.
■ Hydromyelia refers to a
pathologic condition that is
characterized by accumulation
of fluid within an enlarged
central canal of the spinal cord.
■ Possible pathogenic mechanisms
of syringo-/hydromyelia
formation include changes in
cerebrospinal fluid pressure
relationships within the spinal
cord, loss or abnormal
development of spinal
parenchyma, stenosis of the
central canal, and obstruction
of cerebrospinal fluid flow.
■ Concurrent abnormalities of the
cerebellum, caudal brain stem,
and foramen magnum may be the
cause of syringo-/hydromyelia.
Syringomyelia and
Hydromyelia in
Dogs and Cats
Washington State University
Rodney S. Bagley, DVM Patrick R. Gavin, DVM, PhD
Gena M. Silver, DVM, MS Michael P. Moore, DVM, MS
Hege Kippenes, DVM Rebecca Connors, LVT
ABSTRACT: Spinal cord abnormalities are common causes of limb dysfunction in dogs and
cats. With the advent of advanced imaging techniques, intraspinal diseases are more frequent-
ly being diagnosed antemortem. Many intraspinal abnormalities are associated with fluid ac-
cumulation and cyst formation. Spinal cord fluid accumulation may primarily involve the
parenchyma (syringomyelia) or the central canal (hydromyelia). Advanced imaging studies,
such as magnetic resonance imaging, are often necessary for diagnosis. An increased aware-
ness of these diseases is important to identify animals with spinal disease.
S
pinal cord abnormalities are frequent causes of limb dysfunction in dogs
and cats. Numerous diseases have been associated with the spinal cord,1 in-
cluding intervertebral disk abnormalities, vertebral fracture, tumors,
diskospondylitis, myelitis, and congenital malformations. From a diagnostic
standpoint, survey spinal radiographs are often helpful in diagnosing vertebral
fractures, vertebral tumors, and diskospondylitis. Myelography is useful in de-
tecting diseases that compress or expand the spinal cord. Diseases that primarily
or exclusively affect the spinal cord parenchyma without associated vertebral
bony change, however, have been elusive to diagnose with survey radiography
and myelography. Such advanced imaging modalities as magnetic resonance
imaging (MRI) and computed tomography (CT) are being used more frequently
to diagnose spinal disease. With the advent of these newer spinal imaging
modalities, the clinicians’ ability to “see” the spinal cord has vastly improved.
Consequently, spinal cord diseases previously thought to be uncommon are be-
ing diagnosed regularly.
Syringomyelia and hydromyelia are examples of diseases that are recognized
more frequently in the small animal hospital at Washington State University,
where MRI is used as the primary spinal diagnostic imaging modality. Although
previously described in dogs and cats, these diseases were often found only at the
time of necropsy.1–7 Because antemortem diagnosis is now possible, clinical and
diagnostic features of these diseases become important for appropriate manage-
Small Animal/Exotics Compendium May 2000

ment of affected animals. An increased understanding though originating as hydromyelia, may be lined by
of the disease process also offers the potential for devel- glial tissue consistent with a syrinx.8
opment of newer treatments.
CAUSES
TERMINOLOGY Pathologic Mechanisms
Syringomyelia and hydromyelia are cystic abnormalities No single pathologic mechanism adequately explains
of the spinal cord. Syringomyelia refers to abnormal cavi- all instances of syringomyelia and hydromyelia.8 Possible
ties filled with fluid in the substance of the spinal cord causes of cyst formation include changes in CSF pres-
(Figure 1).8 A syrinx refers to one of these cavities. Hy- sure relationships within the spinal cord (as occurs with
dromyelia refers to a pathologic condition characterized hydrocephalus or foramen magnum abnormalities), loss
by accumulation of fluid
within an enlarged central
canal of the spinal cord (Fig-
ure 1). In both conditions,
the fluid that accumulates is
similar, if not identical, to
cerebrospinal fluid (CSF).
Some authors refer to hy-
dromyelia as a communicat-
ing syringomyelia and use the
term syringomyelia to de-
scribe all intraspinal abnor- Figure 1A Figure 1B
mal fluid accumulations.8

DIFFERENTIATING
BETWEEN
SYRINGOMYELIA
AND HYDROMYELIA
Because it is often diffi-
cult clinically and diagnos-
tically to differentiate be-
tween syringomyelia and
hydromyelia, the term sy-
ringo-/hydromyelia is used. Figure 1C Figure 1D
The diagnosis is ultimately
made based on histology. In
hydromyelia, the fluid cavi- H S
ty is lined by ependymal
cells characteristic of the
central canal, whereas a sy-
ringomyelic cavity is usual- H
ly within the spinal cord S
external to the central canal
and is lined by glial cells. In
some instances, differenti-
Figure 1E Figure 1F
ating between the two is
more difficult because an in- Figure 1—(A) Sagittal and (B) transverse T2-weighted magnetic resonance images (MRIs) of the
creasing hydromyelia may thoracolumbar spine of a cat. There is significant increased signal (hyperintensity; whiter area)
destroy or disrupt the epen- consistent with excessive fluid accumulation involving diffuse areas within the spinal cord (ar-
dymal layer with fluid rup- rows). (C) A sagittal T2-weighted MRI of a normal feline spinal cord is shown for comparison.
turing into the surrounding (D) Pathologic specimens from the cat in Figures 1A and 1B at different spinal cord levels show-
spinal cord. These abnor- ing hydromyelia and (E) a combination of hydromyelia (H) and syringomyelia (S). (F) Histolog-
mal fluid-filled areas, al- ic section of the spinal cord in Figure 1E showing hydromyelia (H) and syringomyelia (S).

CEREBROSPINAL FLUID ■ EPENDYMAL CELLS ■ GLIAL CELLS

Compendium May 2000 Small Animal/Exotics

or abnormal development (myelo- epidural space into the spinal cord

dysplasia, such as spinal dysraphism parenchyma. Obstruction of CSF
of weimaraners) of spinal parenchy- flow from the cranium to the spinal
ma, stenosis of the central canal, cord may cause pressure differen-
and obstruction of CSF flow result- tials that affect the spinal cord. In-
ing from inflammation or tumor.8–13 creased or differential CSF pres-
Each of these mechanisms is possi- sures within the spinal cord may
ble in dogs and cats but has not result in vascular compromise to
been definitively proved. the cord, thereby impairing venous
drainage and predisposing to
Extracanalicular Syrinxes parenchymal damage.
Syrinxes that do not communi- Figure 2A
cate with the central canal at any Hydrocephalus
level (extracanalicular syrinxes) are Hydromyelia is often associated
often acquired as a result of spinal with hydrocephalus in humans.8
injury or disease-related damage This has rarely been reported in
(hemorrhage and inflammation).8,13 dogs15 but is likely underrecognized
Extracanalicular syrinxes tend to oc- (Figure 2). Changes in CSF pressure
cur in the central gray matter or in and around the spinal cord may
dorsal and lateral white matter and play a role in the development and
are possibly associated with changes maintenance of a syrinx. An experi-
in vascular distribution (watershed mental hydrocephalic model in dogs
Figure 2B
zones). 13 The fluid-filled cavities has shown that, with increased intra-
tend to be lined by glial or fibroglial Figure 2—(A and B) T1-sagittal magnetic reso- ventricular pressure, increases in the
cells. Hemosiderin-laden macro- nance images from two dogs with hydro- pressure in the syrinx cavity are
phages are commonly found in the cephalus and syringo-/hydromyelia. There is found.16 When ventricular pressures
areas immediately adjacent to the significant decreased signal (hypointensity; are decreased, however, a concurrent
darker area) consistent with excessive fluid ac-
syrinx cavity, suggesting that previ- cumulation involving the fourth ventricle and
decrease in pressure of a similar
ous hemorrhage has occurred. In a cervical spinal cord (arrows). The caudoventral magnitude within the syrinx is not
study in humans, 37% of extra- cerebellum of the dog in Figure 2A is project- found. This has led to the explana-
canalicular syrinxes ruptured through ing into the foramen magnum. (P = posterior) tion that a “ventriculosyringeal
the pia-arachnoid to communicate valve” effect may be present. In
with the subarachnoid space.8 essence, CSF is forced into the sy-
rinx by increased pressure but cannot escape when the
Size and Degree of Abnormality pressure surrounding the cavity decreases. The reasons this
The size and degree of the cystic spinal abnormality occurs are not fully known.16
may give some indication about the underlying cause.
Shorter segments of hydromyelia tend to be acquired Increases in Pressure
and occur in older children and adults.8 Larger defects, Transient increases in intracranial, intrathoracic, or
often extending along the majority of the spinal cord intraabdominal pressure may play a role in the develop-
length, are associated with congenital defects or diseases ment of syringo-/hydromyelia. These transient increas-
acquired early in life. es in pressure may happen with such commonplace
physiologic occurrences as coughing and sneezing in
Abnormal Cerebrospinal Fluid Dynamics humans. Similar mechanisms may exist in dogs. In-
Another important cause of syringo-/hydromyelia in creases in intracranial, intrathoracic, or intraabdominal
humans is abnormal CSF dynamics at the level of the pressure may occur in dogs regularly (e.g., during defe-
fourth ventricle and/or foramen magnum area.8,14 Abnor- cation) and may be a source of increased subarachnoid
mal pressure/fluid dynamics may then result in spinal pressure. Simple movements of the head and spine may
cord cavitation or dilation of the central canal. Proposed also alter subarachnoid pressure.
explanations for this include arterial pulsation of CSF
with pressure waves being transmitted to the cervical Dysequilibration and Movement
cord and increased CSF pressures resulting in trans- of Cerebrospinal Fluid
medullary passage of CSF from the central canal and Recent studies of humans with posterior fossa abnor-

WATERSHED ZONES ■ FIBROGLIAL CELLS ■ VENTRICULOSYRINGEAL VALVE EFFECT

Small Animal/Exotics Compendium May 2000

malities (i.e., Chiari malformations) longata is usually concurrently dis-

have shown that dysequilibration placed caudally, and there may be
and movement of CSF from the fibrosis of the meninges around the
intracranial to the spinal subarach- brain stem and cerebellum. A type
noid space may be the underlying II malformation has the same fea-
factor in perpetuating syringomy- tures, albeit with a meningomyelo-
elia.10 During systole of the cardiac cele at some level in the spinal cord,
cycle, the brain expands slightly to possibly the thoracolumbar area of
accommodate the increase in cere- the spinal cord. A type III malfor-
bral blood flow. CSF is then shift- mation generally refers to a cranial
ed across the foramen magnum to Figure 3A or occipital cervical meningomyelo-
the cranial cervical spinal cord. cele alone without cerebellar or
During diastole, when blood leaves brain stem displacement. Finally, in
the brain, brain volume decreases. Chiari’s original scheme, a type IV
The direction of CSF flow revers- malformation essentially referred to
es—CSF moves from the cranial cerebellar hypoplasia without other
cervical spinal cord to the intracra- associated defects. In modern-day
nial subarachnoid space. usage, the term Chiari malforma-
If the foramen magnum is ob- tion tends to be used in reference to
structed as a result of caudal dis- those features associated with what
placement of the cerebellum, CSF was originally termed a type I mal-
cannot move in either direction. Figure 3B formation.
CSF cannot leave the intracranial Figure 3—(A) Sagittal T2-weighted brain and These malformations are frequent-
space during systole and thus caus- spine and (B) transverse foramen magnum ly associated with hydrocephalus,
es increased intracranial pressure. magnetic resonance images (MRIs) of a dog. and concurrent syringo-/hydro-
The pulsatile increase in pressure is In Figure 3A, the significantly increased signal myelias are commonly encoun-
transmitted down the spinal cord (hyperintensity; whiter area) is consistent with tered. Obstruction of CSF flow at
and appears to be an important excessive fluid accumulation in the cervical the foramen magnum seems to be
factor in perpetuating the syrinx spinal cord (white arrows). The caudoventral the primary mechanism of both of
cerebellum is projecting into the foramen mag-
cavity. CSF may enter the syrinx num area (black arrow). The double-headed these pathologic changes. Similar
through multiple microscopic con- black arrow on the left indicates the phase di- abnormalities may occur in dogs
nections of the syrinx within the rection of the MRI. and other animals (Figure 3). Oth-
subarachnoid space. Reversal of er abnormalities resulting in hy-
these excessive pressure pulsations occurs after decom- drocephalus and a dilated fourth ventricle may also be
pressive surgery (craniectomy and durotomy) of the associated with syringomyelia. The Dandy-Walker syn-
foramen magnum. drome in humans is one such example. With this dis-
ease, there is a malformation resulting in a cystlike ab-
Defects of the Foramen Magnum normality in the cerebellum. The lateral and third
Congenital and acquired defects of the foramen mag- ventricles are commonly dilated concurrently. This is a
num have been described in animals,17 some with simi- congenital problem assumed to be associated with ab-
larities to the Chiari-type malformations in humans.18–23 normal embryogenesis. Examples of a similar syndrome
This group of diseases is primarily associated with ex- have been described in dogs and other animals.24–26
tension of the caudal cerebellum dorsal to the medulla Spinal cord abnormalities have not been described;
oblongata and caudal to the foramen magnum around however, the spinal cords of affected animals may not
the cervical spinal cord and displacement of the medulla have been examined pathologically.
oblongata and fourth ventricle into the cervical spinal The association of nervous tissue defects and external
canal. These abnormalities were originally grouped into bony defects is also not well established. Occipital dys-
four separate entities by Chiari in the late 1800s and are plasia is a congenital abnormality of occipital bone de-
sometimes referred to as Arnold-Chiari malformations.18 velopment, which is characterized by an abnormally
Descriptions of these abnormalities vary somewhat; shaped foramen magnum. This defect, however, is
however, a type I malformation is a cerebellomedullary common in some breeds and often not associated with
abnormality associated with caudal displacement of the clinical signs.17 Two dogs have been reported to have
cerebellum into the foramen magnum. The medulla ob- occipital dysplasia and concurrent cranial spinal cord

CHIARI MALFORMATION ■ MENINGOMYELOCELE ■ HYDROCEPHALUS

Compendium May 2000 Small Animal/Exotics

defects.27 In one, a suspected syrinx sive disease in dogs.

communicating with the dorsal sub- Although uncommon, spinal pain
arachnoid space was found during may also be associated with syringo-
surgery; in the other, a syrinx was /hydromyelia. This is curious because
suspected based on imaging but was many intraspinal diseases are non-
not histologically confirmed. A rela- painful. The pain associated with sy-
tionship between the concomitant ringo-/hydromyelia may result from
conditions is suggested based on in- expansion of the spinal cord with
formation from similarly affected subsequent stretching of nerve roots
humans; however, it is difficult to or the dura. Local inflammation, ei-
prove definitively. Whether these de- ther primary or associated with hem-
fects result from a single congenital orrhage into the syrinx, may also con-
defect is unclear. From previous ob- tribute to the pain.
servations, it appears that many dogs Clinical manifestations of the sy-
with occipital dysplasia do not have ringomyelia-Chiari complex in humans
other associated central nervous sys- include signs related to either brain
tem abnormalities.17 However, if oc- stem, cerebellar, or cervical spinal cord
cipital dysplasia is noted in an ani- Figure 4A involvement. These include ataxia,
mal with clinical signs of cervical pain, sensory and motor tract dysfunc-
spinal cord disease, it would seem tion, and cranial nerve (VIII to XII)
prudent to examine for other con- abnormalities.4–8,10,12
current spinal diseases. A number of dogs and humans
with syringomyelia have associated
CLINICAL FEATURES scoliosis.21,30–42 Although an association
The clinical signs of syringo-/hy- between these types of lesions and sco-
dromyelia reflect spinal cord dysfunc- liosis is not yet defined, it has been
tion. Ataxia is a frequent clinical con- theorized that local lower motor neu-
sequence, as is paresis. Clinical signs ron cell bodies are damaged or de-
reflect the predominant neuroana- stroyed secondary to the cyst. This
tomic area of lesion involvement. For then results in denervation of the asso-
example, if the abnormality occurs in ciated paraspinal musculature, con-
the cervical spinal cord, ataxia of all tributing to asymmetric lateral muscle
limbs and tetraparesis are often pres- tension and subsequent vertebral devi-
ent. If the dorsal portions of the ation. Denervation muscle atrophy on
spinal cord are predominantly in- the convex side of the scoliosis may re-
volved, ataxia may be the most obvi- sult from denervation of the para-
ous clinical sign. With cervical le- Figure 4B spinal musculature. Greater muscle
sions, ataxia and paresis are often Figure 4—(A) Transverse T -weighted and strength on the concave side may de-
1
worse in the pelvic limbs. In some (B) T -weighted magnetic resonance viate the vertebrae toward the normal
images
2
dogs, however, paresis is worse in the (MRIs) from the cervical spinal cord of a side. In some cases, however, we have
seen the opposite occur.
thoracic limbs, a condition that is re- dog at the same spinal level. Syringomyelia
ferred to as central cord syndrome or is present dorsally in the spinal cord. The le-In some instances, syringo-/hydro-
cruciate paralysis.28,29 Somatotopic ori- sion is decreased in signal (hypointensity;
myelia exists without obvious clinical
entation of the spinal cord tracts re- darker area) on the T1-weighted image and signs. In one large study, approxi-
sults in more medial aspects of path- increased in signal (hyperintensity; whiter mately 22% of human patients with
ways projecting to the thoracic and area) on the T2-weighted image. The dou- pathologically confirmed syringo-/
more lateral aspects of pathways pro- ble-headed black arrows on the left indicatehydromyelia had no associated clin-
jecting to the pelvic limbs. A more the phase direction of the MRI. ical signs.8
centrally (medially) occurring lesion
could preferentially affect these more medial pathways DIAGNOSTIC TESTING
and lead to more obvious clinical involvement of the The diagnosis of syringomyelia can be difficult be-
thoracic limbs. We have seen this presentation with both cause the abnormality is often not apparent following
intramedullary (syringomyelia) and extradural compres- routine myelography. Using lumbar injections, it is

OCCIPITAL DYSPLASIA ■ ATAXIA ■ PARESIS ■ PAIN ■ SCOLIOSIS

Small Animal/Exotics Compendium May 2000

Figure 5A
Figure 5—(A) Sagittal T2-weighted magnetic
resonance image (MRI) from the spinal cord
of a normal dog showing truncation artifact
(represented by the linear signal simulating the
central canal; arrows). (B) No similar abnor-
mality of the central canal is seen on the trans-
verse T2-weighted MRIs from same area.

Figure 5B

primarily water and varying

degrees of protein and fat.45
Because water has a lower
CT attenuation coefficient
compared with brain pa-
renchyma, a hypodense le-
sion would be anticipated.45
MRIs of cystic lesions
should have long values of
T1 and T2, resulting in hy-
Figure 6A pointense and hyperintense
Figure 6—(A) Sagittal T2-weighted magnetic signals, respectively (Figure
resonance image (MRI) from a dog with an in- 4).43 Different characteris-
tervertebral disk extrusion (arrow). The in- tics on MRIs, however,
creased signal (hyperintensity; whiter area) may be noted with differ-
cranial to the compression is consistent with ing consistencies of the flu-
edema or syringo-/hydromyelia. (B) Trans- id present.47 In our experi-
verse T2-weighted MRI from a dog with an in- ence, T 2-weighted studies
tervertebral disk extrusion (arrow). The in- are good for determining
creased signal (hyperintensity; whiter area) in the presence of abnormal
the area of the central canal is consistent with
fluid within the spinal cord
syringo-/hydromyelia or malacia.
Figure 6B but tend to overestimate
the size of the cystic abnor-
sometimes possible to fill the central canal with con- mality. In addition, caution should be exercised in over-
trast medium, thus making the central canal apparent. interpreting linear hyperintense lines in the cervical
This is inconsistent; and if contrast does not fill the sy- area because truncation artifacts may have a similar ap-
ringo-/hydromyelic cavity, myelography may be normal pearance to the central canal (Figure 5).46 Truncation
or show only an expanded spinal cord. artifacts appear as lines parallel to the spinal cord and
Other imaging studies, such as CT or MRI, are often may be misinterpreted as the central canal on the sagit-
more helpful in establishing a diagnosis.3,43–46 MRI is tal view. A corresponding transverse view in this area,
often better than is CT in defining intraparenchymal however, indicates no intraparenchymal alterations.
spinal cord abnormalities. Many cystic lesions contain Evidence of syringo-/hydromyelia is not an infre-

INTRAPARENCHYMAL SPINAL CORD ABNORMALITIES ■ TRUNCATION ARTIFACTS

Compendium May 2000 Small Animal/Exotics

quent finding in dogs undergo- from the incised cavity. A biopsy may
ing spinal MRI in our hospital. be obtained from the cyst wall if the
T2-weighted scanning sequences diagnosis is in doubt. The overlying
are helpful in screening animals dura is usually not closed in dogs.
for these types of abnormalities. Posterior fossa decompression is
Increased T 2 signal intensity performed via a suboccipital craniec-
within the spinal cord, however, tomy in dogs and also often requires
is not pathognomonic for sy- a partial laminectomy of C1. If oc-
ringo-/hydromyelia because oth- cipital dysplasia is present, there is a
er lesions (e.g., edema, some fibrous covering in the caudal occipi-
stages of hemorrhage, malacia) Figure 7A tal bone area. This tissue is incised
may have a similar appearance. with a scalpel blade or microscissors.
Dilation of the central canal may If the occipital bone is intact, a high-
occur with compressive myelopa- speed nitrogen-powered drill is use-
thies and other diseases that dam- ful in removing the occipital bone.
age or disrupt spinal cord paren- Similar to performance of a laminec-
chyma (Figure 6). 48 In these tomy, the bone is removed with the
instances, the cystic abnormali- drill to a thin (egg-shell) layer of in-
ties may reverse with appropriate ner cortical bone. The remaining
treatment of the primary disease. bone is removed with rongeurs. The
Sometimes, however, clinically more fibrous dura is then incised
significant syrinxes may develop with a scalpel or scissors. CSF will
Figure 7B
at a later time. flow freely from the area of the dura
Figure 7—(A) Postoperative sagittal and (B)
incision.
transverse T 2-weighted magnetic resonance
TREATMENT images from the dog in Figure 2A with hydro- Before closure, plugging of the cen-
In humans, the treatment of cephalus and syringo-/hydromyelia. A fourth- tral canal at the obex has been recom-
cranial cervical syringomyelia ventricle-to-peritoneal shunt has been placed; mended in humans in an attempt to
with or without caudal fossa ab- the shunt tip is visible in the fourth ventricle prevent flow of CSF from the fourth
normalities remains controver- (black arrows). Air (white arrows) in Figure 7A ventricle into the cervical spinal cord.
sial. In instances where the le- is present in the fourth ventricle and dorsal to Based on more recent pathologic stud-
sions are subclinical or clinical the cerebellum primarily because of surgery. ies, however, this practice is being
signs are mild and nonprogres- questioned and often not performed.19
4,8
sive, no definitive treatment may be needed. If clini- Whether marsupialization of the dura in the foramen
cal signs are progressive, definitive treatment should be magnum is needed is also unclear. Aseptic meningitis is a
considered. Surgical approaches include decompression potential complication, presumably a result of chemical
of the syrinx via myelotomy, posterior fossa decompres- irritation of the nervous tissues and meninges from
sion via a suboccipital craniectomy and associated cer- hemoglobin breakdown products.52 Too few dogs have
vical vertebral laminectomy, and syringosubarachnoid been treated surgically to establish objective criteria for
shunting.14,19–21,49–52 In one report comparing the latter surgical treatment of these abnormalities.23
two procedures, no difference was found between pa- Treatment responses are influenced by the type of
tient groups, with both procedures being equally effec- pathology present. Humans with hydromyelia in asso-
tive in causing syrinx collapse.49 Clouding the issue fur- ciation with hydrocephalus may likely benefit from
ther, some syrinxes have regressed spontaneously, ventriculoperitoneal shunting, whereas those with hy-
resulting in some authors questioning the role of dromyelia that does not communicate with the fourth
surgery as treatment for this problem.50 In addition, di- ventricle may not benefit.8 Extracanalicular syrinxes
rect syrinx drainage without shunting may also be help- that do not communicate with the fourth ventricle may
ful in some cases. require direct shunting. In addition, because this type
Myelotomy and cyst decompression may help relieve of syrinx often results in irreversible damage to spinal
pressure within the syrinx cavity.7,27 Laminectomy over tracts, overall treatment responses may not be as favor-
the affected area is required to access the spinal cord. able as with hydromyelia. Surgical treatment of sy-
Cautious incision into the spinal cord may be per- ringomyelia associated with arachnoid scarring may not
formed with either a scalpel (No. 11 Bard Parker blade) be consistently helpful.51
or microdissecting instruments. CSF will flow freely Fourth ventricular shunting has been performed in

COMPRESSION MYELOPATHIES ■ SHUNTS ■ DECOMPRESSION

Small Animal/Exotics
humans and dogs to treat some abnormalities of CSF
dynamics of the posterior fossa (Figure 7). 23,53 The
shunt is placed from the fourth ventricle into the peri-
toneal cavity. Technically, placement of the proximal
catheter tip into the fourth ventricle may result in ia-
trogenic trauma to the brain stem. Morbidity as high as
42% has been associated with placement of the rostral
catheter tip in humans.53 Clinical signs include cranial
nerve palsies (cranial nerves VII, VIII, and XI), head
tilt, paresis, and ataxia.
Treatment responses depend on appropriate diagnosis
and understanding of the pathophysiologic events that
result in or perpetuate syringomyelia and hydromyelia.
With improved diagnostic capabilities, these diseases
are being diagnosed more frequently in dogs and cats.
Knowledge of these spinal cord diseases should lead to
improved treatments that will improve prognoses for
animals with syringomyelia and hydromyelia.
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About the Authors
Drs. Bagley, Gavin, Silver, Moore, and Kippenes and Ms.
Connors are affiliated with the Department of Clinical Sci-
ences, College of Veterinary Medicine, Washington State
University, Pullman, Washington. Drs. Bagley and Moore
are Diplomates of the American College of Veterinary In-
ternal Medicine, and Dr. Gavin is a Diplomate of the
American College of Veterinary Radiology.