Intraoperative Ultrasonography for Definition of Less Invasive Surgical Technique in Patients with Chiari Type I Malformation

Brock, Roger Schmidt; Taricco, Mario Augusto; Oliveira, Matheus Fernandes de; Oliveira, Marcelo de Lima; Teixeira, Manoel Jacobsen; Bor‐Seng‐Shu, Edson

doi:10.1016/j.wneu.2017.02.003

Cited by 17 publications

(4 citation statements)

References 42 publications

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“…Since CSF leakage is the most common complication, especially in this group [19], we tend to avoid unnecessary duraplasty if there is an acceptable intraoperative dural expansion and if intraoperative ultrasound shows a good decompression of CSF spaces and CSF flow velocities improve through craniovertebral transition. Ultrasound application in Chiari malformation type I craniovertebral stenosis proved to be a reliable tool to decide if duraplasty was required, according to cerebrospinal flow velocities [29]. We believe that ultrasound B-mode and doppler effect can be useful to evaluate if an adequate decompression of neural structures is achieved also in foramen magnum stenosis.…”

Section: Discussionmentioning

confidence: 95%

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2021

Neurosurg Cases Rev

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Section: Discussionmentioning

confidence: 95%

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2021

Neurosurg Cases Rev

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“…These findings are intraoperatively demonstrated using ultrasonographic CSF flow measurement during the dura-splitting technique. 26 …”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Dura-Splitting versus Duraplasty Techniques in Pediatric Chiari I Malformation: A Systematic Review and Meta-Analysis

et al. 2023

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Type I Chiari malformation is a developmental anomaly with various proposed surgical techniques for its management. The dura-splitting technique is a less invasive approach and involves the resection of the outer layer of the dura while sparing the internal layer. While this less-known approach may minimize the complication rates, there are concerns about its efficacy and outcome. Therefore, we have performed a systematic review and meta-analysis of available data on clinical and radiological outcomes of this technique in the pediatric population and compared them to the foramen magnum decompression and duraplasty technique.We have followed the Meta-analysis Of Observational Studies in Epidemiology guidelines in this review. Based on our predefined search strategy, we performed a systematic database search. Subsequently, the article screening process was done based on defined inclusion/exclusion criteria. Following the quality assessment of included studies, two authors performed data extraction. Finally, the extracted data were summarized and presented in form of tables. Forest plots were used to demonstrate the results of the meta-analysis.A review of 8 included studies consisting of 615 patients revealed the significant advantage of the dura-splitting technique in terms of shorter operation duration and hospital stay. The recurrence rate and clinical and radiological outcomes were almost similar between the two surgical techniques. Complication rates were significantly lower in the dura-splitting technique.Dura-splitting can be an effective and safe approach for the management of pediatric Chiari I malformation. However, these results are mostly extracted from observational studies and future randomized controlled trials are recommended.

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“…Chiari malformation type I is a congenital disease characterized by an anatomic defect of the skull base, in which the cerebellum herniates through the foramen magnum into the cervical spinal canal 16,22,23 . Historically, it has been the cerebellar tonsillar herniation has been anatomically defined as 5 mm or greater below the foramen magnum 17,22,23 .…”

Section: Discussionmentioning

confidence: 99%

“…The low availability and high cost of heterologous grafts or dural substitutes makes the reconstruction after posterior fossa decompression a procedure with potential harmful complications related to CSF fistula and its consequences [18][19][20][21][22][23] . A low cost, safe and efficient method for dural closure is a valuable alternative to address these complications [18][19][20][21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

Dural Closure in Chiari I Malformation. Technique Description and Analysis of Results

Brock¹,

Santos²,

Taricco³

et al. 2018

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Introduction. Surgical posterior fossa decompression of Chiari malformation type 1 (CM-I) is recommended in symptomatic patients. The classic surgery is a suboccipital craniectomy and C-1 laminectomy, with duroplasty. However, a range of complications associated with surgical management of CM-I includes pseudomeningocele, CSF leakage, aseptic meningitis, and wound infections, making dural closure and reconstruction one important step to determine morbidity. Our objective is to present a technique of pericranium harvest and dural closure and describe our experience. Methods. A retrospective study was conducted based on records of patients treated in Hospital das Clínicas of the University of São Paulo, diagnosed with CM-I and submitted to posterior fossa decompression from January 2008 until May 2015. We evaluated the occurrence of post-operative complications of symptomatic pseudomeningocele or incisional CSF leak. The occurrence of meningitis, surgical site infection or other complications were also available. Results. A total of 22 patients were evaluated in this study. Sixteen (72.7%) were female patients. Overall, the mean age at the time of surgery was 49 ± 13.6 years-old. Four patients (18%) presented complications: 3 CSF leakages (13.5%) and 1 pseudomeningocele (4.5%). Discussion. Postoperative complications of CM-I are still frequent and determinants of surgical success. We propose a new surgical technique with autologous pericranium graft and duraplasty. Additionally to dural closure, we propose another modality of muscular fascia closure, allowing increased tight closure. Our data corroborate with current literature. Conclusion. Our technique of dural closure using pericranium autologous graft in CM-I is safe and feasible.

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Intraoperative Ultrasonography for Definition of Less Invasive Surgical Technique in Patients with Chiari Type I Malformation

Cited by 17 publications

References 42 publications

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Clinical and Radiological Outcomes of Dura-Splitting versus Duraplasty Techniques in Pediatric Chiari I Malformation: A Systematic Review and Meta-Analysis

Dural Closure in Chiari I Malformation. Technique Description and Analysis of Results

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