Surgical treatment of type I Chiari malformation: the role of Magendie’s foramen opening e tonsils manipulation

Abstract

The treatment for type 1 Chiari malformation (CM 1) is one of the most controversial topics in the neurosurgical field. The present study evaluated two of the most applied surgical techniques to treat CM 1. Method: 32 patients were evaluated and divided in two groups: group 1 had 16 patients that were submitted to decompression of occipital bone and dura mater of the craniovertebral junction (CVJ); group 2 also had 16 patients and in addition to the previous procedure, they were submitted to Magendie's foramen opening e tonsils manipulation. The comparison between the groups included neurological exam and cerebrospinal fluid flow imaging during pre and postoperative periods. Results: Both techniques were equivalents in terms of neurological improvement of the patients (p . 0.05), but the group 2 had more surgical complications, with relative risk of 2.45 (CI 1.55-3.86) for adverse events. Whatever the cerebrospinal fluid flow at CVJ, the patients of the group 1 achieved greater amount of flow than the group 2 (p , 0.05) during the postoperative period. Conclusion: The cranial and dural decompression of the CVJ without arachnoidal violation was the best surgical intervention for treatment of CM 1, between these two compared techniques.

Malformação de Chiari: Relato de caso

“…O tratamento cirúrgico possibilita a melhora sintomatológica e da qualidade de vida, através da descompressão da fossa posterior do crânio com reestabelecimento de fluxo do líquido cefalorraquidiano adequado ao nível de forame magno. A falta de intervenção cirúrgica pode resultar em agravamento da doença e piora dos sintomas (Moro et al, 1999;Vidal et al, 2015).…”

Surgical Management of Chiari Malformation Type One in Adults

“…Vidal CH [23] reported better results and less complications in patients treated by bony and dural decompression only without any violation to the arachnoid after comparison in 32 patients divided into 2 groups, first group treated with decompression without arachnoid violation and the second with tonsils manipulation and magendi opening [23].…”

Prenatally Diagnosed Type II Arnold Chiari Malformations-A Rare Congenital Anomaly with Some Unusual Associated Defects

“…There are number of reports about different approaches of treatment for type I ACM in both paediatric and adult patients. [7,8,9]. As far as treatment for type II ACM is concerned, very few reports are available.…”