Posterior fossa decompression with duraplasty in Chiari surgery: A technical note

Sabba, Marcelo Ferreira; Renor, Beatriz Souza; Ghizoni, Enrico; Tedeschi, Hélder; Joaquim, Andrei Fernandes

doi:10.1590/1806-9282.63.11.946

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…Una minuciosa atención a los detalles es extremadamente importante para minimizar los riesgos del procedimiento y mejorar el resultado del paciente. (13) En el primer y tercer caso clínico presentado en el que se realizó la cirugía no se presentaron complicaciones, evidenciando que la técnica quirúrgica fue la apropiada. la presencia de mielomeningocele..…”

Section: Marín Y Rosado En 2007 Enunclassified

Series de casos de malformación de Arnold Chiari: Hospital Nacional Mario Catarino Rivas, 2008-2018

Lara

Mejía

Reyes

et al. 2021

Rev. Cient. Esc. Univ. Cienc. Salud

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La malformación de Arnold Chiari (MAC) es una enfermedad por primera vez descrita en 1883 y clasificada en 1891 en cuatro grupos. Se ha reportado una prevalencia de malformación de Chiari tipo 1 de 0.24-0.9% de los adultos que se realizan un resonancia magnética cerebral por cualquier motivo. Los síntomas se relacionan a hidrocefalia obstructiva, movimientos oculares anormales y mielomeningocele espinal. Su causa es multifactorial y las manifestaciones clínicas muy variadas. Se relaciona con síndromes de craneosinostosis, síndromes osteopáticos, desórdenes del tejido conectivo, anomalías vertebrales, anomalías cráneofaciales, síndrome de Williams, síndrome de Noonan y neurofibromatosis. El diagnóstico se realiza por resonancia magnética. Casos clínicos: Se presenta una serie de 3 casos de pacientes que acudieron al Hospital Mario Catarino Rivas (HMCR) en el periodo de 2008- 2018. El motivo de consulta fue diferente en cada paciente, siendo: vómito, pérdida de fuerza muscular, disfagia, dolor en miembro superior derecho, paresia y parestesia de miembro inferior y ataxia, aumento del perímetro cefálico. El tipo de malformación fue tipo 1 en dos casos, tipo 2 en un caso. Solo dos de los pacientes se operaron, teniendo evolución posquirúrgicasatisfactoria. Conclusión: La MAC es una patología poco estudiada en el país. No existe una forma de presentación global, por lo que siempre hay que tenerla en cuenta cuando se presente un paciente con alguna de esta sintomatología.

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Section: Marín Y Rosado En 2007 Enunclassified

Series de casos de malformación de Arnold Chiari: Hospital Nacional Mario Catarino Rivas, 2008-2018

Lara

Mejía

Reyes

et al. 2021

Rev. Cient. Esc. Univ. Cienc. Salud

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“…Corresponding author: Bo Xiu, Email: boxiu@scsurgery.com for the disease is decompression, including epidural and intradural decompressions and dural expansive repair, making the cerebrospinal fluid circulation at the foramen magnum unobstructed [3]. At present, the common surgical procedures for the Chiari malformation type I are comprised of posterior fossa decompression (PFD), duraplasty and tonsillectomy [4].…”

Section: Pathological Basis and Surgical Failure Causesmentioning

confidence: 99%

The significance of occipitocervical dura angulation in selection of surgery procedures for Chiari malformation type I

Xiu¹,

Zhang²

2019

Journal of Neurorestoratology

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At present, the common surgical procedures for the Chiari malformation type I are comprised of posterior fossa decompression, duraplasty and tonsillectomy. Some neurosurgeons prefer these so called minimally invasive surgeries. However, there are still some failures for patients undergoing the above surgeries in clinical practice. Analyzing causes of many surgical failures, the author put forward the anatomical concept of occipitocervical dura angulation (ODA). The ODA is defined as the included angle between the cerebral dura mater and spinal dura mater at the posterior foramen magnum on the median sagittal plane. For Chiari malformation type I without atlantoaxial instability, the selection of appropriate surgeries and accurate evaluation on the effect of the decompression can be realized after the comprehensive analysis both on the severity of tonsil herniation and the ODA. Tonsillectomy may be needed to add to posterior fossa decompression (PFD) and duraplasty for Chiari malformation type I with the ODA being the larger obtuse angle and/or the tonsil herniation to the level of arcus posterior atlantis.

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“…Multiple additional pathologies accompany CM-1 malformations [Tables 1 and 2 ]. [ 3 6 7 9 10 ] These include the following: 24% skeletal abnormalities, 40%–65% syrinx formation, hydrocephalus, 42% scoliosis, 12% basilar invagination, and 12.7% occipital-atlantal hypermobility (e.g., associated with Ehlers–Danlos syndrome). In Passias et al .…”

Section: Introductionmentioning

confidence: 99%

“…There are various pros and cons for performing posterior fossa decompression only (PFDO) vs. posterior fossa decompression with duraplasty (PFDD) for patients with CM-1 [Tables 1 and 2 ]. [ 2 4 10 ] In 1992, Sabba et al . performed PFDD for CM-1 where the tonsils were >5 mm below the FM; they determined that fusion was not indicated [ Table 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…performed PFDD for CM-1 where the tonsils were >5 mm below the FM; they determined that fusion was not indicated [ Table 1 ]. [ 10 ] In Dlouhy et al . (2017), 389 CM-1 patients (both pediatric and adult) had PFDD; the authors observed a 100% obstruction rate of CSF at the level of the tonsils, with an added 21.1% incidence of obstruction at the Foramen of Magendie [ Table 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Definitions and treatments for chiari-1 malformations and its variants: Focused review

Epstein¹

2018

Surg Neurol Int

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Background:Reviewing the neurosurgical literature demonstrated that spinal neurosurgeons rarely (0.78%) diagnose chiari-1 malformation (CM-1) in adults on magnetic resonance (MR) studies defined by tonsillar descent >5 mm below the foramen magnum (FM). Children, averaging 10 years of age, exhibit CM-1 in 96/100,000 cases. According to the literature, fewer spinal neurosurgeons additionally recognize and treat the low lying cerebellar tonsil (LLCT) syndrome.Methods:The normal location of the cerebellar tonsils on cranial/cervical MR averages 2.9 mm ± 3.4 mm above or up to 3 mm below the FM. The neurosurgical literature revealed that most neurosurgeons diagnose and treat CM-1 where the tonsils are >5 mm to an average of 12 mm below the FM. Fewer spinal neurosurgeons additionally diagnose and treat the LLCT syndrome defined by <5 mm of tonsillar descent below the FM.Results:According to the neurosurgical literature, many neurosurgeons perform cranial/spinal decompression with/without fusion and/or duraplasty for CM-1. Fewer neurosurgeons perform these procedures for CM-1 and the LLCT syndrome, for which they additionally perform preoperative cervical traction under anesthesia, and the postoperative placement of occipital neurostimulators (ONS) for intractable headaches following chiari-1/LLCT surgery.Conclusion:Reviewing the literature revealed that spinal neurosurgeons rarely diagnose CM-1, and treat them with decompressions with/without fusions and/or duraplasty. Fewer spinal neurosurgeons diagnose/treat both the CM-1 and LLCT syndromes, perform preoperative traction under anesthesia, and place ONS for persistent headaches following CM-1 surgery.

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Posterior fossa decompression with duraplasty in Chiari surgery: A technical note

Cited by 8 publications

References 20 publications

Series de casos de malformación de Arnold Chiari: Hospital Nacional Mario Catarino Rivas, 2008-2018

Series de casos de malformación de Arnold Chiari: Hospital Nacional Mario Catarino Rivas, 2008-2018

The significance of occipitocervical dura angulation in selection of surgery procedures for Chiari malformation type I

Definitions and treatments for chiari-1 malformations and its variants: Focused review

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