There is significant uncertainty around the management of post-traumatic syrinx. Symptoms onset insidiously and can be debilitating, necessitating the need for appropriate intervention. Pathogenesis remains enigmatic, and consequently a multitude of different operative techniques to reconstruct homeostatic cerebrospinal fluid flow mechanism have been trialled, with no consensus on their efficacy.
A systematic literature search was conducted from eleven electronic databases. Quality assessment was conducted using a modified Newcastle-Ottawa system. Information was extracted by two authors and analysed using odds ratio and risk ratio as statistical summary effect sizes.
A total of 12 studies were included in this review, encompassing 745 patients (491 arachnoidolysis, 254 Shunting). Overall evidence quality ranged from poor to fair. Odds Ratio for post-operative neurological deterioration was 0.33 (22.1% vs 45.6%; 95% CI, 0.19, 0.55; P < 0.0001), in favour of arachnoidolysis. Rates of surgical reintervention were found to be lower in the arachnoidolysis group compared with those treated with shunting (16.7% vs 30.1%; OR, 0.39; 95% CI, 0.15, 0.97; P = 0.04). Symptomatic improvement was found to be significantly higher in the arachnoidolysis group (69.6% vs 28.7%; OR, 5.33; 95% CI, 1.43, 19.82; P = 0.01). No differences were found between total, major and minor complication rates and radiological regression between the two procedures.
Discussion and Conclusions
This systematic review and meta-analysis endorse the position of arachnoidolysis as favourable option to shunting. This view is formed on the evidence provided on the superior odds ratio for arachnoidolysis in the analysis of post-operative neurological deterioration, surgery revision rates and improvement in symptomatic outcomes, with no difference in complication rates when compared with shunting. Both procedures lack long-term follow-up data therefore interpretation of results must be made with caution. Future studies must aim to determine the underlying mechanism that drives the formation of post-traumatic syrinx.