Your preparation begins with a comprehensive evaluation. This typically includes detailed MRI scans (imaging tests that use magnetic fields to create detailed pictures of your brain and spine) of your brain and entire spine to characterise the syrinx and identify underlying causes. Additional studies, such as CT scans (imaging tests using X-rays to create detailed cross-sectional images), CSF flow studies, or nerve conduction tests (diagnostic tests that measure how well electrical signals move through your nerves), may be requested based on your specific situation.

Pre-operative assessments include:

• Blood tests
• Chest X-rays
• Cardiac evaluation to ensure you can safely undergo anaesthesia

You will meet with the anaesthesia team to discuss your medical history and anaesthesia plan.

In the weeks before surgery, your neurosurgeon will provide specific instructions. These typically include stopping certain medications, particularly blood thinners, at specified intervals before your procedure. Arrange for someone to accompany you home after discharge and help during your initial recovery.

The night before surgery, you will need to fast from midnight. Follow all instructions about medications you should take or avoid on the morning of surgery. Arrive at the hospital at your scheduled time, wearing comfortable clothing and bringing minimal personal items.

On the day of surgery, you will be admitted and prepared for the operating theatre. An intravenous line will be placed for medications and fluids. The anaesthesia team will administer general anaesthesia, ensuring you remain comfortable and unaware throughout the procedure.

For posterior fossa decompression, you will be positioned face down with your head secured. Your surgeon makes an incision at the back of your head and neck, then carefully removes the necessary bone. The procedure typically takes several hours, depending on complexity.

Throughout surgery, the neurophysiology team monitors your spinal cord and nerve function. This continuous feedback helps guide the surgical team and protect neurological structures. Your vital signs are closely watched by the anaesthesia team.

After completing the surgical objectives, your surgeon closes the wound in layers. A drain may be placed temporarily to prevent fluid accumulation. You are then awakened from anaesthesia and transferred to the recovery area.

Following surgery, you will spend time in a high-dependency or intensive care unit for close monitoring. Nursing staff will regularly check your neurological function, vital signs, and wound site. Pain medication is administered to keep you comfortable.

You may experience some headache, neck stiffness, and discomfort, which are managed with appropriate medications. Early mobilisation begins within a day or two, guided by your medical team. A physiotherapist will help you sit up and begin gentle movements safely.

Hospital stay typically ranges from several days to a week, depending on the procedure performed and your recovery progress. Before discharge, your team ensures your pain is controlled with oral medications, you can move safely, and you understand your home care instructions.

Operative time depends on the procedure performed. Posterior fossa decompression typically takes several hours. Shunt placement procedures may take a couple of hours. More complex cases involving tumour removal or multiple issues may require longer. Your neurosurgeon can provide a more specific estimate during your consultation based on your planned surgery.

Surgery aims to stabilise your condition and prevent worsening. Many patients may experience symptom improvement, particularly for pain and progressive weakness, though individual results vary and improvement cannot be guaranteed. Nerve damage present before surgery may not fully recover. Symptoms present for a longer duration before treatment are less likely to completely resolve. Your neurosurgeon can discuss realistic expectations based on your specific situation during consultation.

Initial assessment occurs during your hospital stay. Full evaluation of surgical success requires time. Follow-up MRI scans at several months show whether the syrinx is reducing. Neurological improvement may continue for an extended period. Regular follow-up appointments track your progress and treatment response over this period.

The syrinx can recur in some cases, particularly if the underlying cause is not fully addressed or if a shunt malfunction occurs. Regular follow-up with MRI scans monitors for recurrence. Symptoms returning after initial improvement warrant prompt evaluation. Revision surgery may be needed in some instances.

Recovery time varies by individual and occupation. Most patients with desk-based jobs return to work within several weeks. Physically demanding occupations may require several months before full duties can resume. Your neurosurgeon can provide specific guidance based on your procedure and job requirements.

For patients with small, stable, minimally symptomatic syrinxes, observation with regular MRI monitoring may be appropriate. Pain management through medications and physiotherapy can help manage symptoms. Progressive or significantly symptomatic syringomyelia generally requires surgical treatment to prevent worsening. Your neurosurgeon can advise whether conservative management is suitable for your case.

Initial restrictions include avoiding bending, lifting, and twisting for several weeks. Driving is restricted until cleared by your surgeon. Swimming and submersion of your wound must wait until healing is complete. Contact sports and strenuous exercise require medical clearance. Specific restrictions depend on your procedure and recovery progress.

Physiotherapy may benefit most patients recovering from syringomyelia surgery. Your therapist guides you through exercises to safely improve strength, mobility, and function. The extent of rehabilitation needed depends on your preoperative condition and surgical procedure. Your medical team can arrange appropriate physiotherapy as part of your recovery plan.