title: Arachnolysis or cerebrospinal fluid diversion for adult-onset syringomyelia? A Systematic review of the literature.
abstract: OBJECTIVE
  To identify surgical practice patterns in the literature for nonpediatric syringomyelia by systematic review and to determine the following: 1) What is the best clinical practice of cerebrospinal fluid (CSF) diversion to maximize clinical improvement or to achieve the lowest recurrence rate? 2) Does arachnolysis, rather than CSF diversion, lead to prolonged times to clinical recurrence?
  
  
  METHODS
  A database search comprising PubMed, Cochrane Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane Database of Systematic Reviews was conducted to find pertinent articles on postinfectious, posttraumatic, or idiopathic syringomyelia.
  
  
  RESULTS
  An advanced PubMed search in August 2012 yielded 1350 studies, including 12 studies meeting Oxford Centre for Evidence-Based Medicine criteria for level IV evidence as a case series, with a total of 410 patients (mean age, 39 years). Data on 486 surgeries were collected. Mean follow-up data were available for 10 studies, with a mean follow-up time of 62 months. On regression analysis, increased age had a significant correlation with a higher likelihood of having clinically significant recurrence on mean follow-up (P < 0.05). The use of arachnolysis in surgery was associated with a longer duration until clinically symptomatic recurrence (P = 0.02). Data on mortality were unavailable. The mean number of surgeries per patient across all studies was 1.20 (range, 0.95-2.00).
  
  
  CONCLUSIONS
  With postinfectious and posttraumatic etiologies, arachnolysis was the only surgical treatment to have a statistically significant effect on decreasing recurrence rates. More prospective, randomized, controlled studies are required to reach a clear consensus.
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors: George M
authors: GM
authors: Ghobrial
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors: Richard T
authors: RT
authors: Dalyai
authors: Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors: Mitchell G
authors: MG
authors: Maltenfort
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors: Srinivas K
authors: SK
authors: Prasad
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors: James S
authors: JS
authors: Harrop
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: Ashwini.Sharan@jefferson.edu.
authors: Ashwini D
authors: AD
authors: Sharan
mesh_terms: D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000473:pathology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013595:Syringomyelia / Q000601:surgery*; D016896:Treatment Outcome
keywords: Arachnolysis; Syringomyelia; Syringopleural shunt; Syringosubarachnoid; Syrinx