The adhesions are sometimes called tethering and the surgery is called untethering the spinal cord. This results in greater cerebrospinal fluid flow in the central canal and any other channels that the fluid can find in the spinal cord. Shunting of the cyst alone usually does not provide lasting results while removal of adhesions alone seem to be more effective. When a surgeon cannot find adhesions they usually place a shunt. Neurological examinations often may not be as sensitive as the patient's own perception of fatigue spasticity spasms and pain.
Most neurosurgeons are reluctant to operate until they see neurological evidence of progression.
In summary surgery on the cyst should not be done without trying to address the cause of the syrinx. Shunting alone has a higher incidence of failure. If there is tethering of the spinal cord the tethering alone may cause fatigue weakness increased spasticity and pain. Unfortunately adhesions are often difficult to see on MRI and can often form again after the surgery. To prevent this many surgeons are using dural grafts to provide more room and reduce the contact between the spinal cord and the dura.