Chiari I “malformation”—an acquired disorder?

Welch, Keasley; Shillito, John; Strand, Roy D.; Fischer, E; Winston, Ken R.

doi:10.3171/jns.1981.55.4.0604

Cited by 155 publications

(58 citation statements)

References 21 publications

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“…However, this pressure theory has not been proven in cases of syringes associated with a Chiari I malformation and, when taken with the observation of cerebellar tonsillar descent after lumboperitoneal shunting [20, 69, 70, 71, 72, 73, 74], cannot be recommended as a primary procedure of choice.…”

Section: Discussionmentioning

confidence: 99%

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Krieger

McComb

Levy³

1999

Pediatr Neurosurg

131

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A wide variety of surgical adjuvants to the standard bony decompression have been advocated in the treatment of the Chiari I malformation, especially when the tonsillar herniation is associated with hydrosyringomyelia. These include various shunting procedures, duroplasty, obex plugging, and resection of the cerebellar tonsils. Our practice has been to avoid these adjuvants and to perform a simple limited occipital craniectomy, C₁ laminectomy, and dural opening. The dura mater is left open and overlain with oxidized cellulose. To evaluate the efficacy of this more limited procedure, a retrospective review was performed of the medical records of 31 consecutive patients treated over a 6-year period. Twenty-six (84%) of these patients had an associated spinal cord syrinx; all underwent the same procedure. The follow-up period ranged from 15 to 93 months, with all patients having at least one postoperative magnetic resonance imaging at 6 months. Twenty-three of the 26 patients (88%) who presented with a syrinx had significant resolution of the syrinx on follow-up scans with concomitant improvement of presenting signs and symptoms. Of the remaining 3 patients, 1 had progressive hydrocephalus and received a ventriculoperitoneal shunt, with symptom resolution. In the other 2 patients the syrinx did not diminish; both received syringopleural shunts. Postoperative morbidity includes a 26% incidence of headaches, of which half resolved within 5 days, and only 1 persisted beyond 2 weeks. Nausea and vomiting occurred in 16%. Neither of these figures significantly exceeds those of other large surgical series in which the dura mater was closed with a patch graft. Three patients (10%) did have a postoperative cerebrospinal fluid leak; all responded to bedside suturing without further sequelae. This study indicates that a simple bone removal and open dural decompression of the cervicomedullary junction is a safe, effective operative treatment for Chiari I malformation in children. Shunts, duroplasty, obex plugging, and tonsillar resection offer no benefit regarding the outcome when our series is compared to others in which such adjuvants were used.

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Section: Discussionmentioning

confidence: 99%

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Krieger

McComb

Levy³

1999

Pediatr Neurosurg

131

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“…The cerebellar tonsils usually resume a more normal position after the mass effect of hematoma has been removed. 9) Therefore, the tonsillar herniation in our patient was probably not directly associated with the supratentorial hematoma.…”

Section: Discussionmentioning

confidence: 95%

Progression of Pre-existing Chiari Type I Malformation Secondary to Cerebellar Hemorrhage -Case Report-

Kojima

Mayanagi

Okui

2009

Neurol. Med. Chir.(Tokyo)

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“…Mori et al thought that since the majority of Chiari malformations are congenital, the association of a Chiari I malformation, syringomyelia and GHD might be one of the midline anomaly syndromes [5]. On the other hand, Welch et al reported cases with acquired Chiari malformation, some of whom had syringomyelia as well [6]. We believe that the cases of syringomyelia without a Chiari malformation are explained by birth injury rather than by the midline anomaly syndrome, and the association of hypopituitarism with syringomylia supports the primary role of birth injury in the pathogenesis of hypopituitarism.…”

Section: Discussionmentioning

confidence: 99%

Incomplete Growth Hormone Secretion with Pituitary Stalk Transection and Syringomyelia

Asakura

Ishikawa

Tachibana

et al. 1993

Clin Pediatr Endocrinol

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Abstract. We report the case of a short girl with incomplete GH secretion, who was born by breech delivery with severe asphyxia. GH responses to provocation tests, including insulin and clonidine, and during sleep were partially preserved. Her IGF-I level was very low. MRI showed transection of the pituitary stalk with an ectopic posterior lobe, and syringomyelia involving the whole spinal cord without a Chiari I malformation.

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Chiari I “malformation”—an acquired disorder?

Cited by 155 publications

References 21 publications

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Progression of Pre-existing Chiari Type I Malformation Secondary to Cerebellar Hemorrhage -Case Report-

Incomplete Growth Hormone Secretion with Pituitary Stalk Transection and Syringomyelia

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