Long-Term Outcomes of a New Minimally Invasive Approach in Chiari Type 1 and 1.5 Malformations: Technical Note and Preliminary Results

Minimally Invasive Craniocervical Decompression for Chiari 1 Malformation: An Operative Technique

“…Another way to perform the extradural decompression is by removing only the atlanto-occipital ligament, but this decision remains controversial. 9,[12][13][14] We report a minimally invasive technique to decompress the CVJ in patients with CM-1. This procedure allows preservation of the extensor muscles of the neck and the muscle attachment at the spinous process of C2.…”

Letter to the Editor. Perioperative complications in patients older than 80 years of age

“…The authors are correct in stating that minimally invasive spine surgery (MISS) techniques have been used since 2016 to achieve extradural bony decompression of the craniocervical junction (CCJ). [2][3][4][5][6] However, in 2019 Quillo-Olvera et al 7 described in detail how to perform a microscopic technique very similar to that reported by Mandel et al, through a 2-cm skin incision by using a Gelpi retractor to address the bony decompression of CCJ in a patient with Chiari malformation type I. The MISS procedure described by Quillo-Olvera et al 7 allowed intradural exploration, and the authors at that time pointed out some of the procedure-related advantages also reported by Mandel et al 1 Due to the novelty and similarities of the approaches presented by Mandel et al 1 and Quillo-Olvera et al, 7 we consider some points to be worth clarifying.…”

“…We cite in our article authors who have presented these novel minimally invasive alternatives. [1][2][3][4][5] Similarly to the authors of these previous reports, we performed a 2-to 3-cm 2 bony decompression (as stated in the Methods section and shown in Video 1 of our article), but we did not include postoperative 3D CT scans in our report as multiple groups have reported achieving adequate FM bony decompression using this MIS technique. [1][2][3][4][5] Instead, our focus was on prospectively evaluating the pathophysiology of CSF flow dynamics and syrinx cavity expansion using MRI in CCJS.…”

“…[1][2][3][4][5] Similarly to the authors of these previous reports, we performed a 2-to 3-cm 2 bony decompression (as stated in the Methods section and shown in Video 1 of our article), but we did not include postoperative 3D CT scans in our report as multiple groups have reported achieving adequate FM bony decompression using this MIS technique. [1][2][3][4][5] Instead, our focus was on prospectively evaluating the pathophysiology of CSF flow dynamics and syrinx cavity expansion using MRI in CCJS. We read with great interest the case report published by Quillo-Olvera et al 6 of a 16-year-old patient with Chiari malformation, but we did not cite this article as the report was not associated with CCJS and also in part because we cited other authors' reports of larger series using a similar surgical technique.…”

“…We read with great interest the case report published by Quillo-Olvera et al 6 of a 16-year-old patient with Chiari malformation, but we did not cite this article as the report was not associated with CCJS and also in part because we cited other authors' reports of larger series using a similar surgical technique. [1][2][3][4][5] We emphasize that the novelty of the procedure reported in our paper lies in the combination of an MIS decompression with a durectomy and obexostomy targeting the pathophysiology of CCJS in adult patients. All of our patients had CCJS.…”