Suboccipital craniectomy with or without duraplasty: what is the best choice in patients with Chiari type 1 malformation?

Abstract

The best surgical treatment for Chiari malformation is unclear, especially in patients with syringomyelia. We reviewed the records of 16 patients who underwent suboccipital craniectomy at our institution between 2005 and 2008. Of the six patients who did not undergo duraplasty, four showed improvement postoperatively. Two patients without syringomyelia showed improvement postoperatively. Of the four patients with syringomyelia, three showed improvement, including two with a decrease in the cavity size. One patient showed improvement in symptoms but the syringomyelia was unchanged. The cavity size increased in the one patient who did not show improvement. Among the 10 patients who underwent duraplasty, improvements were noted in four of the five patients without syringomyelia and in all of the five with syringomyelia. There is a suggestion that patients with syringomyelia may have a higher likelihood of improvement after undergoing duraplasty. Key words: Chiari type 1, syringomyelia, suboccipital craniectomy, duraplasty.craniectomia suboccipital com ou sem duroplastia: qual a melhor escolha em pacientes com malformação de chiari tipo 1? resumo A melhor opção de tratamento cirúrgico na malformação de Chiari é desconhecido, especialmente em paciente com siringomielia. Nós revisamos casos de 16 pacientes submetidos à craniectomia suboccipital em nossa instituição de 2005 à 2008. Dos 6 pacientes que não foram submetidos à duroplastia, quatro tiveram melhora pós operatória. Dois pacientes sem siringomielia tiveram melhora pós operatória. Dos quatro pacientes com siringomielia, três tiveram melhora, incluindo dois com diminuição do tamanho da cavidade. Um paciente teve melhora da sintomatologia mas a siringomielia não se modificou. Dez pacientes foram submetidos à duroplastia. Melhora foi observada em 4 de 5 pacientes sem siringomielia e 5 de 5 casos com siringomielia. Há uma sugestão de que pacientes com siringomielia possam ter uma maior taxa de melhora após serem submetidos à duroplastia. Palavras-chave: Chiari tipo 1, siringomielia, craniectomia suboccipital, duroplastia. Correspondence Flávio Ramalho Romero

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

“…Munshi et al pointed out that surgical results are significantly worse with the non-duraplasty technique (21). Romero and Pereira reported that the syrinx regressed in all of five patients with syringomyelia who underwent duraplasty concluding that duraplasty is more effective in cases with associated syringomyelia (26). In our series, the syrinx cavity regressed in 92.3% of the duraplasty group compared to 12.5% in the nonduraplasty group which is statistically significant (p<0.01).…”

Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation

“…25 This artificially created cistern magna improves CSF flow, leading to resolution of syringomyelia. 26 The lower rates of clinical response and higher rates of reoperation with dural-sparing procedures further support the use of duraplasty. 27 Furthermore, with an experienced surgical team, the rate of CSF-related complications associated with duraplasty, which has been reported to be higher when compared to dural-sparing procedures (18.5% compared to 1.8%), may be insignificant compared with the clinical advantages that duraplasty provides.…”

Posterior fossa decompression with tonsillectomy in 104 cases of basilar impression, Chiari malformation and/or syringomyelia

“…Regarding the cerebellar tonsils, the majority of the neurosurgeons [21][22][23][24][25][26] leave them intact, performing especially the opening of the fourth ventricle, as we performed in 192 cases of our casuistic. Other surgeons 10,12,23 , as observed in recent publications, recommend the dissection of the arachnoidal adherences of the tonsils and vessels and opening of the fourth ventricle.…”