The central canal is a narrow channel filled with cerebrospinal fluid that runs down the middle of the spinal cord. It is continuous above with the fourth ventricle and ends below in a small widening in the conus medullaris. It is lined by ependymal cells and in adults is often partly closed off.
| Location | Centre of the grey commissure, running the length of the spinal cord |
|---|---|
| Parts |
|
| Connections |
A remnant of the neural tube cavity that carries a small amount of cerebrospinal fluid; it has little active role in adults.
Syringomyelia most commonly presents as a cape-like bilateral loss of pain and temperature sensation in the upper limbs (from decussating spinothalamic fibres crossing in the central cord adjacent to the syrinx) with preserved touch and proprioception (dorsal column fibres are lateral to the syrinx). Progressive wasting of the intrinsic hand muscles follows from anterior horn cell involvement. Chiari I malformation (cerebellar tonsils herniating through the foramen magnum) is the most common cause, with CSF flow obstruction driving syrinx formation. Posterior fossa decompression (suboccipital craniectomy) reverses the CSF flow obstruction and allows the syrinx to collapse over months.
Chiari I malformation with tonsillar herniation below the foramen magnum obstructs CSF flow and creates a pressure differential that drives syrinx formation in the cervical and thoracic cord, producing the classic cape distribution sensory loss from crossing spinothalamic fibres; suboccipital decompression and C1 laminectomy with duraplasty restores CSF flow and allows syrinx regression in 70-80% of patients.
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