Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Silva, José Alberto Gonçalves da; Holanda, Maurus Marques de Almeida

doi:10.1590/s0004-282x2003000300009

Cited by 27 publications

(26 citation statements)

References 36 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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. Furthermore, they recommend tonsillectomy as a protection against slump, eliminating the compressive effect over the medulla and spinal cord, as described by Williams 25 , as well as it contributes to the creation of a large artificial cisterna magna, which facilitates an upward migration of the hindbrain structures.…”

Section: Discussionmentioning

confidence: 98%

“…It frequently comes in association with other congenital anomalies such as atlas assimilation, Klippel-Feil syndrome, Sprengel's deformity, CM, platybasia and SM as reported by many authors [8][9][10][11][12][13] . Its association with others deformities is directly related to the theory of embryogenetic error.…”

Section: Discussionmentioning

confidence: 99%

“…All patients underwent "osteodural-neural decompression" previously described by Gonçalves da Silva et al 10 . This study was approved by the Ethics Committee of the Hospital Unimed, João Pessoa, Brazil.…”

Section: Methodsmentioning

confidence: 99%

“…The high prevalence of BI associated with CM in the Northeast of Brazil was reported by many authors [8][9][10][11][12][13] , although there is no suitable known reason for this fact.…”

mentioning

confidence: 99%

See 3 more Smart Citations

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

Silva¹,

Santos²,

Melo³

et al. 2011

Arq. Neuro-Psiquiatr.

Self Cite

View full text Add to dashboard Cite

The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM) and/or syringomyelia (SM) is based on the restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction through the creation of a large artificial cisterna magna. A small suboccipital craniectomy has been emphasized to avoid caudal migration of the hindbrain structures into the vertebral canal. Nevertheless, the results showed downward migration of the hindbrain related to that type of craniectomy. The authors present, otherwise, the results of 104 cases of BI, CM and/or SM, whose surgical treatment was characterized by a large craniectomy with the patient in the sitting position, tonsillectomy, large opening of the fourth ventricle and duraplasty with creation of a large artificial cisterna magna. A significant upward migration of the posterior fossa structures was detected by postoperative magnetic resonance imaging. Key words: basilar impression, Chiari malformation, hindbrain herniation, tonsillectomy, craniovertebral decompression, syringomyelia.Descompressão da fossa posterior com tonsilectomia em 104 casos de impressão basilar, malformação de Chiari e/ou siringomielia RESUMO O principal objetivo no tratamento cirúrgico da impressão basilar, malformação de Chiari e/ou siringomielia fundamenta-se na restauração dinâmica do líquido cefalorraqueano ao nível da transição craniovertebral e criação de ampla cisterna magna. Uma craniectomia suboccipital de pequenas dimensões foi proposta para evitar a migração caudal de estruturas rombencefálicas no canal vertebral. Entretanto, os resultados evidenciaram migração caudal do rombencéfalo. Os autores apresentam, por outro lado, os resultados de 104 casos de malformação de Chiari e/ou siringomielia, nos quais o tratamento cirúrgico se baseou em ampla craniectomia com o paciente em posição sentada, tonsilectomia, abertura ampla do quarto ventrículo e enxerto dural com consequente criação de ampla cisterna magna. Uma significante migração cranial das estruturas da fossa posterior foi detectada pelo emprego pós-operatório da ressonância magnética. Palavras-Chave: impressão basilar, malformação de Chiari, herniação rombencefálica, tonsilectomia, descompressão craniovertebral, siringomielia.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The high prevalence of BI associated with CM in the Northeast of Brazil was reported by many authors [8][9][10][11][12][13] , although there is no suitable known reason for this fact.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Silva¹,

Santos²,

Melo³

et al. 2011

Arq. Neuro-Psiquiatr.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Surgical treatment was indicated based on the impacted cisterna magna, the paraparesis and the non effective treatment of the pain. Osteodural-neural decompression of the posterior fossa was carried out with the patient in sitting position 10 (Fig 3). During this procedure we observed the following abnormalities (Fig 4): compression of Impacted cisterna magna Silva et al the fourth ventricle as well as the foramen of Magendie by the cerebellar tonsils which closed this foramen, fi lled the cisterna magna and migrated downwards into the cervical spinal canal (no adherences to the neighboring structures were observed).…”

Section: Casementioning

confidence: 99%

Impacted cisterna magna without syringomyelia associated with lancinating headache, throbbed nuchal pain and paraparesis treated byposterior fossa decompression

Silva¹,

Costa

Melo³

et al. 2007

Arq. Neuro-Psiquiatr.

Self Cite

View full text Add to dashboard Cite

-A 29-year-old woman with acute lancinating headache, throbbed nuchal pain and subacute paraparesis underwent brain MRI in supine position that depicted: the absence of the cisterna magna, filled by non herniated cerebellar tonsils and compression of the brain stem and cisternae of the posterior fossa, which are aspects of the impacted cisterna magna without syringomyelia and without hydrocephalus. During eight days, pain was constant and resistant to drug treatment. Osteodural-neural decompression of the posterior fossa, performed with the patient in sitting position, revealed: compression of the brainstem, fourth ventricle and foramen of Magendie by herniated cerebellar tonsils, which were aspirated. Immediately after surgery, the headache and nuchal pain remmited. MRI depicted the large created cisterna magna and also that the cerebellar tonsils did not compress the fourth ventricle, the foramen of Magendie and the brainstem, besides the enlargement of posterior fossa cisternae. Four months after surgery, headache, nuchal pain and paraparesis had disappeared but hyperactive patellar and Achilles reflexes remained.KEY WORDS: headache, nuchal pain, craniovertebral malformation, tight cisterna magna, impacted cisterna magna, Chiari malformation, posterior fossa decompression, paraparesis, herniated tonsils.Cisterna magna impactada sem siringomielia associada a cefaléia lancinante, dor na nuca terebrante e paraparesia tratadas com descompressão da fossa posterior RESUMO -Uma paciente de 29 anos de idade com quadro agudo de cefaléia lancinante, dor terebrante na nuca e paraparesia subaguda foi submetida a RM do encéfalo, em posição supina, que revelou: ausên-cia da cisterna magna, preenchida por tonsilas cerebelares não herniadas e compressão do tronco encefá-lico e das cisternas da fossa posterior, compatíveis com o diagnóstico de cisterna magna impactada sem siringomielia e sem hidrocefalia. Por oito dias a dor foi constante e resistente aos analgésicos. Com a paciente em posição sentada, foi realizada descompressão osteodural-neural da fossa posterior associada a aspiração das tonsilas cerebelares. Os achados perioperatórios foram caracterizados por herniação das tonsilas cerebelares que comprimiam o tronco cerebral, o quarto ventrículo e o forame de Magendie. No pós-operatório imediato houve remissão da cefaléia e da dor na nuca. A RM evidenciou a cisterna magna recém-criada, alargamento do quarto ventrículo e das cisternas do tronco encefálico. Quatro meses depois, a paciente continuava sem cefaléia, sem dor na nuca e sem paraparesia. Entretanto, permaneceu a hiperatividade dos reflexos patelares e aquileus.

show abstract

Adult Chiari malformation and sleep apnoea

et al. 2005

View full text Add to dashboard Cite

Chiari malformation (CM) is primarily characterised by herniation of the cerebellar tonsils through the foramen magnum. Clinically, two main types of CM represent the vast majority of cases: type I (in adults) and type II (in infants). CM may result in neuronal impairment of the brainstem, upper spinal cord and cranial nerves. Part of the afferent and efferet systems and the central respiratory controlling system are located in the cranium-cervical transition and may be damaged in these pathologies, leading to respiratory disorders, such as respiratory failure and death. The ventilatory responses to exogenous and endogenous stimuli, such as responses to hypoxia and hypercapnia, are usually diminished, and apnea may be manifested and detected during sleep, allowing for the diagnosis. This study is a review of the relationship between sleep apnoea and adult CM.

show abstract

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Cited by 27 publications

References 36 publications

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

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

Impacted cisterna magna without syringomyelia associated with lancinating headache, throbbed nuchal pain and paraparesis treated byposterior fossa decompression

Adult Chiari malformation and sleep apnoea

Contact Info

Product

Resources

About