Posterior decompression of the craniovertebral junction in syringomyelia combined with Chiari-1 malformation in children

Sanakoeva, A. V.; Korshunov, A E; Kadyrov, Sh U; Khukhlaeva, E A; Kushel, Yu V

doi:10.17116/neiro201781348-56

Cited by 4 publications

(2 citation statements)

References 55 publications

(98 reference statements)

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“…As such, duraplasty is a more reliable treatment choice in patients with syringomyelia or a higher grade of cerebellar tonsil herniation, whereas simple extradural decompression is commonly not advised in children with syringomyelia. 61,62 In the absence of a syrinx, posterior fossa decompression without duraplasty seems to offer similar clinical improvement and is less costly or time-consuming. 56 In theory, the advantage of our TA B L E 1 Summary of patient characteristics technique is the lower chance of postoperative complications such as CSF leak, pseudomeningocele, or aseptic meningitis, while also being adequate for patients with or without moderate syringomyelia.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the degree of posterior fossa enlargement was significantly correlated with the likelihood of a positive postoperative outcome. As such, duraplasty is a more reliable treatment choice in patients with syringomyelia or a higher grade of cerebellar tonsil herniation, whereas simple extradural decompression is commonly not advised in children with syringomyelia 61,62 . In the absence of a syrinx, posterior fossa decompression without duraplasty seems to offer similar clinical improvement and is less costly or time‐consuming 56 .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%