Foramen Magnum Decompression and Duraplasty is Superior to Only Foramen Magnum Decompression in Chiari Malformation Type 1 Associated with Syringomyelia in Adults

Gürbüz, Mehmet Sabri; Berkman, Mehmet Zafer; Ünal, Emre; Akpinar, Elif; Gok, Sevki; Orakdogen, Metin; Aydın, Salih

doi:10.4184/asj.2015.9.5.721

Cited by 25 publications

(13 citation statements)

References 24 publications

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“…31,32 Duraplasty was found to be superior to the non-duraplasty group in ACM-I with syrinx, although there was a slightly higher complication rate in the duraplasty group. 33 The duraplasty procedure was a more reliable choice in tonsillar herniation > 10 mm and in patients when symptom duration was < 36 months in ACM-I with syrinx. 33 Although progression-free survival was found to be less in patients without duraplasty, especially in syringomyelia compared with duraplasty in some studies, 27,30,33 we found dural splitting to be safe and effective in our series even in syringomyelia.…”

Section: Discussionmentioning

confidence: 98%

“…33 The duraplasty procedure was a more reliable choice in tonsillar herniation > 10 mm and in patients when symptom duration was < 36 months in ACM-I with syrinx. 33 Although progression-free survival was found to be less in patients without duraplasty, especially in syringomyelia compared with duraplasty in some studies, 27,30,33 we found dural splitting to be safe and effective in our series even in syringomyelia. Although there was a higher reoperation rate after bony decompression alone compared with decompression with duraplasty, clinical improvement was not higher after primary decompression with duraplasty in a systematic review and in a meta-analysis.…”

Section: Discussionmentioning

confidence: 98%

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Endoscopic Management of Arnold-Chiari Malformation Type I with or without Syringomyelia

Ratre

Yadav

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Endoscopic Management of Arnold-Chiari Malformation Type I with or without Syringomyelia

Ratre

Yadav

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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“…To avoid excessive bleeding and other complications, duraplasty should be skipped depending on venous anatomy. 33) …”

Section: Discussionmentioning

confidence: 99%

Chiari Type 1 Malformation-induced Intracranial Hypertension with Diffuse Brain Edema Treated with Foramen Magnum Decompression: A Case Report

Fukuoka

Nishimura

Hara

et al. 2017

NMC Case Report Journal

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Chiari type 1 malformation (CM1) rarely causes papilloedema, which is indicative of high intracranial pressure with or without ventricular dilatation. Furthermore, concomitant brain parenchymal abnormalities have not been reported to date. In this paper, the authors report on a young woman of CM1-induced intracranial hypertension (ICH) with diffuse brain edema with a focus on venous sinus assessment, and discuss the surgical strategy. A 24-year-old woman presented to Nagoya University Hospital complaining of 4-year history of severe occipital headache and blurry vision with slowly progressive worsening. Head and whole spine MRI showed a CM1 with diffuse white matter hyperintensities (WMH) on T2-weighted imaging and narrowed brain sulci without hydrocephalus. Lumbar puncture revealed extremely high opening pressure. Detailed blood examination and other radiographical imaging studies denied the presence of tumor, collagen disease, encephalitis and other entities. Head magnetic resonance venography and angiography demonstrated severe transverse sinus stenosis on both sides. Foramen magnum decompression was performed to alleviate the ICH by restoration of cerebrospinal fluid (CSF) stagnation at the foramen magnum with successful outcome. The patient completely recovered from preoperative symptoms immediately after surgery. The diffuse WMH and narrowing brain sulci have been resolving. The most feasible explanation for this complicated pathophysiology was ICH induced by CM1 led to transverse sinus collapse, resulting in diffuse WMH as a result of venous hypertension. This case report is the first illustration of successful surgical treatment of CM1 with diffuse brain edema with a focus on venous sinus assessment.

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“…Despite the persistent debate, there is little evidence to support either posterior fossa decompression without dural opening or posterior fossa decompression with duraplasty is more suitable for a given patient. [24][25][26][27] Several studies show that the dura mater is actually comprised of several different layers, ranging from 3 to 5. [28][29][30][31] According to the three-layer interpretation, the outermost layer measures only 2 micrometers in thickness, is comprised of fibroblasts, and harbors elastin and collagen fibers.…”

Section: Introductionmentioning

confidence: 99%

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

Florian¹,

Pop²,

Florian

2021

Int J Clin Pract

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Objective: To present an alternative surgical technique in treating cases of Chiari I Malformation with mild-to-moderate syringomyelia after decompressive suboccipital craniectomy: incising only the outer layer of the dura mater, then dissecting it from the inner layer without opening the latter. Patients and methods:We utilized this technique in a short series of three cases who were admitted to our department for mild symptoms such as intermittent headache and dissociated sensory loss in the upper limbs, caused by a Chiari Malformation Type I. The patients were placed in the sitting position. We performed a reduced median suboccipital craniectomy and resection of the posterior arch of C1 adapted to the level of tonsil descent, from a limited superior half to complete resection. Afterward, we incised the outer dural layer, while sparing the inner one. Using a fine dissector, we then split apart the outer and inner layers to the margin of the craniectomy. Through the transparency of the inner layer and the arachnoid, the cerebellum and the medulla were visible and pulsating. An autologous fascia duraplasty was then performed. Results:The postoperative course was favorable in all cases, the patients being discharged without any deficits and with complete symptom resolution. Follow-up at 3, 6, and 12 months after surgery revealed a significant reduction in brainstem compression and syringomyelia. Conclusions:Interlayer dural split technique can be used effectively in treating symptomatic cases of type I Chiari malformation in adults, with mild-to-moderate syringomyelia. It is less invasive than opening the dura and possibly more effective than decompressive craniectomy and C1 laminectomy alone. This technique must be validated in a larger case-control series. Highlight s• Chiari 1 treatment involves the decompression of the foramen magnum via craniectomy, duraplasty, and resection of cerebellar tonsils.• These methods have varying success rates and there is much debate whether more or less invasive methods are required.• Our method aims to combine the invasive and less-invasive methods by only incising the outer layer of the dura mater, without entering into the subdural spaces, and performing a duraplasty to further prevent any CSF leakage.

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Foramen Magnum Decompression and Duraplasty is Superior to Only Foramen Magnum Decompression in Chiari Malformation Type 1 Associated with Syringomyelia in Adults

Cited by 25 publications

References 24 publications

Endoscopic Management of Arnold-Chiari Malformation Type I with or without Syringomyelia

Endoscopic Management of Arnold-Chiari Malformation Type I with or without Syringomyelia

Chiari Type 1 Malformation-induced Intracranial Hypertension with Diffuse Brain Edema Treated with Foramen Magnum Decompression: A Case Report

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

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