Retrospective study of patients with Chiari: malformation submitted to surgical treatment

Taricco, Mario Augusto; Melo, Luiz Ricardo Santiago

doi:10.1590/s0004-282x2008000200008

Cited by 13 publications

(15 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The indications for surgical treatment of CM I-SM include exhibiting signs and symptoms of nervous system impairments and rapid progression of the disease. The aim of surgical treatment is to enlarge the posterior cranial fossa volume, relieve compression of the cerebellar tonsil and liquid of SM to the brain stem and spinal cord, and improve the blood circulation of the cerebrospinal fluid and spinal cord, thereby allowing control of progressive nerve damage and promoting disease rehabilitation (Heiss et al, 1999;Schijman, 2004;Zhang et al, 2000Zhang et al, , 2004Huang et al, 2005;Attenello et al, 2008;Liu et al, 2008;Tarieeo and Melo, 2008;Wu et al, 2010;Bao et al, 2011;Ma et al, 2012). Thus, regardless of the surgical approaches applied, the criteria for success should be an enlarged posterior cranial fossa volume, relief of compression of the hindbrain, construction of a smooth circulation channel of the cerebrospinal fluid, recovery of the physiological circulatory state of the cerebrospinal fluid, and elimination of compression and damage of SM to the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

et al. 2015

View full text Add to dashboard Cite

ABSTRACT. This study aimed to investigate the therapeutic effects of craniocervical decompression with duraplasty and cerebellar tonsillectomy for the treatment of Chiari malformation-I with syringomyelia (CM I-SM). From January 2005 to December 2011, 127 patients with CM I-SM underwent craniocervical decompression with duraplasty and cerebellar tonsillectomy and the therapeutic effects of these surgeries were evaluated using Tator scores. No patient in this study died or showed disease deterioration after the surgery. Reexamination by magnetic resonance imaging (MRI) showed that the cisterna magna was obviously larger after the operation in all but one patient. Moreover, syringomyelia (SM) was reduced in 76 patients. CM I-SM symptoms disappeared or decreased in 112 patients after following discharge. Follow-up was conducted in 84 of the patients and 79 of these patients exhibited improved symptoms. A second MRI re-examination showed that the cisterna magna was successfully constructed in 44 Treatment of Chiari malformations patients; 42 of these patients showed further eliminated or obviously reduced SM. Craniocervical decompression with duraplasty and cerebellar tonsillectomy achieved favorable therapeutic effects. Thus, craniocervical decompression with duraplasty and cerebellar tonsillectomy is a rational surgical approach with beneficial clinical effects. The proposed approach may have useful applications in the treatment of CM I-SM.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In 1907, the disease was formally known as the Arnold-Chiari malformation (Schwalbe and Gredig, 1907). However, an increasing number of scholars named this disease the Chiari malformation (Tarieeo and Melo, 2008;Williams, 2008).…”

Section: Introductionmentioning

confidence: 99%

Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

et al. 2015

View full text Add to dashboard Cite

show abstract

“…It is associated with syringomyelia in 30-70% of cases (1,10). Diagnosis of CM-1 is made based on both clinical and radiological findings (29). Clinical signs result either from compression of neural structures at the craniovertebral junction or from the cavity of SM (25,28).…”

Section: Discussionmentioning

confidence: 99%

“…In 1883, John Cleland (29) described deformities of the brainstem, cerebellum, spina bifida and medullary cavitation. In 1891, Hans Chiari described three types of anomaly of the craniovertebral junction based on a few cases, and in 1895, described the three types and added a fourth type based on a higher number of cases (9, 29).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

Gürbüz¹,

Karaaslan²,

Çalışkan³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

AIM:The surgical results for foramen magnum decompression (FMD) with and without duraplasty in Chiari Malformation type 1 (CM-1) were compared retrospectively. MATErIAL and METHods:Thirty-nine cases of CM-1 with and without syringomyelia (SM) were included. There were 18 patients in the nonduraplasty and 21 in the duraplasty group. Syringomyelia, tonsillar herniation (TH), preoperative symptom duration, and postoperative SM size were compared. rEsuLTs: No significant difference was found between improvement in the duraplasty group (81%) and the non-duraplasty group (61.1%). In cases whose symptom duration was 0-36 months, improvement in the duraplasty group (93%) was significantly better than in the nonduraplasty group (50%) (p<0.01). The rate of syrinx regression was 92.3% in the duraplasty group and 12.5% in the non-duraplasty group (p<0.05). In cases with SM, the improvement was 21.4% in the non-duraplasty group compared to 78.6% in the duraplasty group (p=0.056). In cases with TH greater than 10 mm, the improvement was 66.7% in the non-duraplasty group, whereas all six cases (100%) in the duraplasty group had improved. CoNCLusIoN:In SM associated cases, cases with TH greater than 10 mm, and whose symptom duration is less than 36 months, duraplasty is a more reliable choice despite a slightly higher rate of complications. BuLGuLAr: Duraplastili (%81) ve duraplastisiz grubun (%61,1) iyileşme oranları arasında anlamlı fark bulunmadı. Preoperatif semptom süresi 0-36 ay arasında olan olgularda; duraplastili grubun iyileşme oranı (%93) duraplastisiz gruba göre (%50) anlamlı oranda yüksekti (p<0.05). Sirenks boyutunda küçülme oranı duraplastili grupta % 92,3 iken duraplastisiz grupta % 12.5 idi (p<0.05). SM bulunan olgularda; duraplastili grubun iyileşme oranı % 78,6, duraplastisiz grubun iyileşme oranı ise % 21,4 idi (p=0.056). TH'un 10 mm'den fazla olduğu olgularda; duraplastisiz grubun iyileşme oranı % 66,7 iken, duraplastili 6 olgunun tamamı iyileşmişti (%100).soNuÇ: SM'li olgularda, TH'un 10 mm'den fazla olduğu olgularda ve semptom süresi 36 aydan kısa olan olgularda duraplasti hafif yüksek komplikasyon oranı olmakla birlikte daha iyi bir seçenek olarak düşünülmüştür.

show abstract

“…Combined series, which included both pediatric and adult patients, constituted 61 reports (42%). [5][6][7]9,11,12,[25][26][27]34,37,38,40,43,44,46,47,52,53,55,63,66,67,70,73,74,76,83,87,90,91,94,96,100,102,103,106,110,111,114,115,117,121,126,127,129,130,132,135,[138][139][140]…”

Section: General Informationmentioning

confidence: 99%

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Arnautovic

Splavski

Boop

et al. 2015

PED

185

View full text Add to dashboard Cite

OBJECT Chiari malformation Type I (CM-I) is a hindbrain disorder associated with elongation of the cerebellar tonsils, which descend below the foramen magnum into the spinal canal. It occurs in children and adults. Clinical symptoms mainly develop from alterations in CSF flow at the foramen magnum and the common subsequent development of syringomyelia. METHODS The authors reviewed English-language reports of pediatric, adult, and combined (adult and pediatric) surgical series of patients with CM-I published from 1965 through August 31, 2013, to investigate the following: 1) geographical distribution of reports; 2) demographics of patients; 3) follow-up lengths; 4) study durations; 5) spectrum and frequency of surgical techniques; 6) outcomes for neurological status, syrinx, and headache; 7) frequency and scope of complications; 8) mortality rates; and 9) differences between pediatric and adult populations. Research and inclusion criteria were defined, and all series that contained at least 4 cases and all publications with sufficient data for analysis were included. RESULTS The authors identified 145 operative series of patients with CM-I, primarily from the United States and Europe, and divided patient ages into 1 of 3 categories: adult (> 18 years of age; 27% of the cases), pediatric (≤ 18 years of age; 30%), or unknown (43%). Most series (76%) were published in the previous 21 years. The median number of patients in the series was 31. The mean duration of the studies was 10 years, and the mean follow-up time was 43 months. The peak ages of presentation in the pediatric studies were 8 years, followed by 9 years, and in the adult series, 41 years, followed by 46 years. The incidence of syringomyelia was 65%. Most of the studies (99%) reported the use of posterior fossa/foramen magnum decompression. In 92%, the dura was opened, and in 65% of these cases, the arachnoid was opened and dissected; tonsillar resection was performed in 27% of these patients. Postoperatively, syringomyelia improved or resolved in 78% of the patients. Most series (80%) reported postoperative neurological outcomes as follows: 75% improved, 17% showed no change, and 9% experienced worsening. Postoperative headaches improved or resolved in 81% of the patients, with a statistical difference in favor of the pediatric series. Postoperative complications were reported for 41% of the series, most commonly with CSF leak, pseudomeningocele, aseptic meningitis, wound infection, meningitis, and neurological deficit, with a mean complication rate of 4.5%. Complications were reported for 37% of pediatric, 20% of adult, and 43% of combined series. Mortality was reported for 11% of the series. No difference in mortality rates was seen between the pediatric and adult series. CONCLUSIONS Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications. Furthermore, surgeons may benefit from comparing published data with their own. In the future, operative CM-I reports should provide all details of each case for the purpose of comparison.

show abstract

Retrospective study of patients with Chiari: malformation submitted to surgical treatment

Cited by 13 publications

References 8 publications

Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Contact Info

Product

Resources

About