Surgical management of syringomyelia-Chiari complex

Ergün, Rüçhan; Akdemir, Gökhan; Gezici, Ali Rıza; Tezel, Kutay; Beşkonaklı, Etem; Ergüngör, Fikret; Taşkın, Yamaç

doi:10.1007/s005860000157

Cited by 31 publications

(15 citation statements)

References 34 publications

(27 reference statements)

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“…4,8,13,14,[16][17][18][19]21,22,29,36,45,48,49,57,62,71,79,82,84,85,95,105,113,[118][119][120][122][123][124][125]127,128,137,149,151 In the pediatric series that reported an association of syringomyelia, of a total of 1678 patients, 673 (40%) harbored a syrinx. [1][2][3]15,24,28,[30][31][32][33]35,41,42,50,51,…”

Section: Incidence Of Syringomyeliamentioning

confidence: 99%

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Arnautovic

Splavski

Boop

et al. 2015

PED

199

107

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OBJECT Chiari malformation Type I (CM-I) is a hindbrain disorder associated with elongation of the cerebellar tonsils, which descend below the foramen magnum into the spinal canal. It occurs in children and adults. Clinical symptoms mainly develop from alterations in CSF flow at the foramen magnum and the common subsequent development of syringomyelia. METHODS The authors reviewed English-language reports of pediatric, adult, and combined (adult and pediatric) surgical series of patients with CM-I published from 1965 through August 31, 2013, to investigate the following: 1) geographical distribution of reports; 2) demographics of patients; 3) follow-up lengths; 4) study durations; 5) spectrum and frequency of surgical techniques; 6) outcomes for neurological status, syrinx, and headache; 7) frequency and scope of complications; 8) mortality rates; and 9) differences between pediatric and adult populations. Research and inclusion criteria were defined, and all series that contained at least 4 cases and all publications with sufficient data for analysis were included. RESULTS The authors identified 145 operative series of patients with CM-I, primarily from the United States and Europe, and divided patient ages into 1 of 3 categories: adult (> 18 years of age; 27% of the cases), pediatric (≤ 18 years of age; 30%), or unknown (43%). Most series (76%) were published in the previous 21 years. The median number of patients in the series was 31. The mean duration of the studies was 10 years, and the mean follow-up time was 43 months. The peak ages of presentation in the pediatric studies were 8 years, followed by 9 years, and in the adult series, 41 years, followed by 46 years. The incidence of syringomyelia was 65%. Most of the studies (99%) reported the use of posterior fossa/foramen magnum decompression. In 92%, the dura was opened, and in 65% of these cases, the arachnoid was opened and dissected; tonsillar resection was performed in 27% of these patients. Postoperatively, syringomyelia improved or resolved in 78% of the patients. Most series (80%) reported postoperative neurological outcomes as follows: 75% improved, 17% showed no change, and 9% experienced worsening. Postoperative headaches improved or resolved in 81% of the patients, with a statistical difference in favor of the pediatric series. Postoperative complications were reported for 41% of the series, most commonly with CSF leak, pseudomeningocele, aseptic meningitis, wound infection, meningitis, and neurological deficit, with a mean complication rate of 4.5%. Complications were reported for 37% of pediatric, 20% of adult, and 43% of combined series. Mortality was reported for 11% of the series. No difference in mortality rates was seen between the pediatric and adult series. CONCLUSIONS Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications. Furthermore, surgeons may benefit from comparing published data with their own. In the future, operative CM-I reports should provide all details of each case for the purpose of comparison.

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Section: Incidence Of Syringomyeliamentioning

confidence: 99%

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Arnautovic

Splavski

Boop

et al. 2015

PED

199

107

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“…Navarro et al [7] favored a tailored posterior fossa craniectomy without dural opening as the initial surgical procedure resulting in the occurrence of fewer complications and considerable success rates. In addition, foramen magnum decompression combined with a syringosubarachnoid shunt performed during the same operation was strongly recommended by Ergun et al [8]. Although the complete pathogenic mechanisms are yet to be elucidated, it is widely accepted that the descended cerebellar tonsils cause craniospinal dissociation and impaired cerebrospinal fluid (CSF) flow which is a prerequisite for syrinx formation.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Chiari Malformation: Analysis of 128 Cases

Guo

Wang²,

Jiang

et al. 2007

Pediatr Neurosurg

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Objective: A variety of surgical interventions have been recommended for patients with Chiari malformations (CMs). In this study, we have evaluated the intraoperative findings and clinical outcome in different-aged patients with CMs undergoing posterior fossa decompression. Methods: Sixteen pediatric and 112 adult cases with CMs underwent suboccipital craniectomy and wide duraplasty as well as autogenous bone grafting in selected cases. The clinical outcome was assessed by evaluation of postoperative signs and symptoms and magnetic resonance imaging of the craniocervical junction. Results: The most striking intraoperative finding was the presence of a very thin membrane over the opening of the central canal; the occurrence of this membrane in pediatric patients was significantly higher than that in adults (94 and 43%, respectively; p < 0.05, Fisher’s exact probability test). During the immediate postoperative period, 81% of pediatric CMs and 90% of adult CMs showed improved symptomatology and magnetic resonance imaging revealed favorable findings comprising syrinx collapse or reduction of the syrinx diameter in 14 (88%) pediatric and 92 (82%) adult CMs. During discharge from hospital, 103 (90%) patients with CMs type I and 11 (85%) with CMs type II achieved good results. However, there was a statistically significant difference in the occurrence of poor results between patients treated with bony fusion and those without fusion (24 vs. 6%;p < 0.05, Fisher’s exact probability test). The incidence of vertebral instability was markedly augmented in pediatric CMs in comparison to adult CMs (19 vs. 2%; p < 0.01, Fisher’s exact probability test). Conclusions: Suboccipital decompression and duraplasty with autogenous bone grafts in selected cases are effective treatments for most patients with CMs. A higher incidence of a special membrane over the obex and atlantoaxial instability were closely associated with childhood CMs.

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“…In that sense, foramen magnum decompression (FMD) is a rational and widely accepted method. 4,7,9,10) On the other hand, SS shunting is one of the major surgical procedures for syringomyelia. 3,11) Only FMD or in combination with SS shunting is superior to only placing a shunt.…”

Section: Discussionmentioning

confidence: 99%

Syringomyelia Associated With Paget Disease of the Skull

Hori

Kurimoto

Umemura

et al. 2013

Neurol. Med. Chir.(Tokyo)

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A 38-year-old man presented with a rare case of syringomyelia associated with Paget disease of the skull. Syringosubarachnoid (SS) shunting was performed. We speculate that deformation of the skull secondary to Paget disease caused narrowing of the foramen magnum with progressive impairment of the cerebrospinal fluid circulation, which led to syringomyelia and neurological symptoms. SS shunting is safe, effective, and technically simple, so may be a useful initial treatment for syringomyelia associated with Paget disease of the skull.

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Surgical management of syringomyelia-Chiari complex

Cited by 31 publications

References 34 publications

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Surgical Management of Chiari Malformation: Analysis of 128 Cases

Syringomyelia Associated With Paget Disease of the Skull

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