Reformation of the Posterior Atlanto-Occipital Membrane following Posterior Fossa Decompression with Subsequent Constriction at the Craniocervical Junction

Tubbs, R. Shane; Wellons, John C.; Oakes, W. Jerry; Blount, Jeffrey P.

doi:10.1159/000069092

Cited by 17 publications

(9 citation statements)

References 10 publications

(3 reference statements)

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“…2c) on postoperative imaging. During their revision surgery, we invariably noticed that the previously resected posterior atlanto-occipital membrane overlying the dura had been scarred and caused restriction of the dura, requiring direct, sharp decompression [16]. Other patients showed residual dorsal compression on repeat postoperative imaging.…”

Section: Discussionmentioning

confidence: 99%

Revision Chiari Surgery in Young Children: Predictors and Outcomes

Chae

Greenfield

2021

Pediatr Neurosurg

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Introduction: Children aged 0–6 years with Chiari malformation (CM) often present with atypical symptoms and require revision surgery more often than older children. We studied characteristics and outcomes of CM patients in this age-group who underwent one or more revision surgeries to assess how often revision surgery is necessary and successful in this age-group. Methods: We retrospectively reviewed patients who were diagnosed with CM 1 or CM 1.5 and surgically treated with posterior fossa decompression (PFD) with or without duraplasty before their 7th birthday. Basic demographics, preoperative presentation, operative details, and postoperative outcomes were analyzed. Results: Forty patients (mean age 3.2 ± 1.7 years, 35% female) were reviewed. The most common presenting symptoms were headache, dysphagia, and respiratory problems. Eight patients required one or more revision surgeries 11.6 ± 7.6 months on average after their initial surgery. Comparing the revision and no revision groups, dysautonomia was significantly more common prior to initial surgery in the children requiring revision (37.5 vs. 3.1%, p = 0.02). The revision group also trended toward more dysphagia (75.0 vs. 46.9%, p = 0.24) and respiratory problems (75.0 vs. 40.6%, p = 0.12). The most frequent reasons for reoperation were symptom recurrence (6/8), residual posterior fossa compression (3/8), significant scar tissue formation (2/8), ventral brainstem compression (1/8), and suspected craniocervical instability (1/8). Of the 8 children undergoing reoperation, surgery achieved symptom resolution or improvement in 5, while 3 had unchanged symptoms. Two patients underwent a third surgery, after which 1 showed improvement and the other did not. This last patient showed short-term improvement after a fourth surgery but had symptom recurrence 12 months later. Discussion/Conclusion: Oropharyngeal and respiratory problems are particularly common in children aged 0–6 years with CM. Presentation with dysautonomia or other signs of brainstem compression will often predict an additional surgery will be needed after an initial PFD. Symptom recurrence is the most frequent reason for reoperation, and revision surgeries lead to improved clinical outcomes in the majority but not all of these young patients. Surgery in very young children is successful, but reoperation should be integrated into an up-front discussion algorithm particularly in children with severe symptoms.

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Section: Discussionmentioning

confidence: 99%

Revision Chiari Surgery in Young Children: Predictors and Outcomes

Chae

Greenfield

2021

Pediatr Neurosurg

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“…Декомпрессия позвоночной артерии имела положительный результат. Улучшение кровотока подтвердилось на послеоперационной ангиографии [46].…”

Section: обзорыunclassified

Scoliotic spine deformity in children and adolescents associated with the craniovertebral junction pathology

Nv¹

2014

Vopr. neirokhir.

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This literature review is devoted to the clinical and pathogenic aspects of the relationship between Chiari type I malformation (CMT) and scoliosis. The view of the clinical presentation development in CMT associated with scoliosis is considered on the basis of both the CSF dynamics disturbances and vascular pathology of the craniovertebral junction. The role of the posterior atlanto-occipital membrane is evaluated. Case reports of the risk factors for scoliosis progression in patients with CMT are presented.

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“…For example, growth hormone deficiency has been linked to CM-I in 5%-20% of patients with growth hormone deficiency. 20,77 This endocrine deficiency in children is believed to be a physiological mechanism for insufficient development of the posterior fossa with resultant tonsillar herniation. 78 While the posterior fossa volume of patients with growth hormone deficiency has not been found to be significantly smaller, research has shown certain bone structures to be underdeveloped, similar to those commonly noted in patients with CM-I.…”

Section: Endocrinopathymentioning

confidence: 99%

Associated disorders of Chiari Type I malformations: a review

Loukas

Shayota

Oelhafen

et al. 2011

FOC

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A single pathophysiological mechanism of Chiari Type I malformations (CM-I) has been a topic of debate. To help better understand CM-I, the authors review disorders known to be associated with CM-I. The primary methodology found among most of them is deformation of the posterior cranial fossa, usually with subsequent decrease in volume. Other mechanisms exist as well, which can be categorized as either congenital or acquired. In understanding the relationship of such disorders with CM-I, we may gain further insight into the process by which cerebellar tonsillar herniation occurs. Some of these pathologies appear to be true associations, but many appear to be spurious.

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Reformation of the Posterior Atlanto-Occipital Membrane following Posterior Fossa Decompression with Subsequent Constriction at the Craniocervical Junction

Cited by 17 publications

References 10 publications

Revision Chiari Surgery in Young Children: Predictors and Outcomes

Revision Chiari Surgery in Young Children: Predictors and Outcomes

Scoliotic spine deformity in children and adolescents associated with the craniovertebral junction pathology

Associated disorders of Chiari Type I malformations: a review

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