Surgical prognosis in hindbrain related syringomyelia

Asgari, Siamak; Engelhorn, Tobias; Bschor, Martin; Sandalcioglu, I. Erol; Stolke, D.

doi:10.1034/j.1600-0404.2003.01357.x

Cited by 24 publications

(23 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A previous study of surgical prognosis in hindbrain-related syringomyelia, based on 31 patients, found that no patients who received bipolar tonsillar cautery experienced clinical improvement and, in fact, showed a trend toward deteriorated outcome with tonsillar cautery. 2 Our finding of improved outcome with tonsillar cautery was not concordant with this previous study. However, we did conduct our study on a larger sample of patients with syrinx (n = 171), controlling for other variables known to affect outcome.…”

Section: Tonsillar Cautery Independently Predicts Syrinx Improvementcontrasting

confidence: 57%

Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation

Stanko¹,

Lee²,

Rios³

et al. 2016

PED

View full text Add to dashboard Cite

OBJECT Chiari Type I malformation involves caudal displacement of the cerebellar tonsils below the foramen magnum, which obstructs normal cerebrospinal fluid flow and increases intracranial pressure. Certain aspects of its surgical treatment remain controversial. A retrospective study was conducted to assess the efficacy of tonsillar cautery on syrinx resolution among pediatric Chiari patients undergoing cervicomedullary decompression. METHODS A retrospective cohort study was performed for patients 0–18 years of age who underwent surgical correction for Chiari Type I malformation with syrinx between 1995 and 2013. Basic demographic information was collected as well as data for preoperative symptoms, prior surgical history, perioperative characteristics, and postsurgical outcomes. Descriptive statistics were performed in addition to bivariate analyses. Candidate predictor variables were identified based on an association with tonsillar cautery with p < 0.10. Forward stepwise likelihood ratio was used to select candidate predictors in a binary logistic regression model (Pin = 0.05, Pout = 0.10) most strongly associated with the outcome. RESULTS A total of 171 patients with Chiari Type I malformation with syrinx were identified, and 43 underwent tonsillar cautery. Patients who underwent tonsillar cautery had 6.11 times greater odds of improvement in their syrinx (95% CI 2.57–14.49, p < 0.001). There was no effect of tonsillar cautery on increased perioperative complications as well as the need for repeat decompressions. CONCLUSIONS Tonsillar cautery is safe and effective in the treatment of Chiari Type I malformation with syrinx and may decrease time to syrinx resolution after cervicomedullary decompression. Tonsillar cautery does not increase postoperative complications in pediatric Chiari Type I malformation patients.

show abstract

Section: Tonsillar Cautery Independently Predicts Syrinx Improvementcontrasting

confidence: 57%

Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation

Stanko¹,

Lee²,

Rios³

et al. 2016

PED

View full text Add to dashboard Cite

show abstract

“…These include the size of the suboccipital craniectomy, a decompression with or without an opening of the dura mater, an opening of the dura with or without closing or patching with dural graft, tonsillectomy, and so on. 1,2,12,19,21,22,24 Overall, surgery has proven to be quite effective. 6,18,24 The most frequently reported complications following CM surgery include pseudomeningocele, 16,25 meningitis, 4 CSF leakage, 25 and cerebellar ptosis.…”

Section: Discussionmentioning

confidence: 99%

Acute respiratory arrest following partial suboccipital cranioplasty for cerebellar ptosis from Chiari malformation decompression

Xiao

Luciano

Benzel

2008

FOC

View full text Add to dashboard Cite

Cerebellar ptosis is a rare complication following Chiari malformation decompression, and generally is the result of a very large suboccipital craniectomy. This can lead to the descent of the cerebellum through the craniectomy defect, which in turn may result in cerebellar herniation through the surgical defect as well as the reestablishment of contact between the cerebellar tonsils and the brainstem. In addition, dorsal adherence of the herniated cerebellum to the dura mater or dural patch and an associated obstruction of cerebrospinal fluid flow at the cervicomedullary junction may ensue. Such a result is not desirable, in that it reproduces or mimics the pathoanatomical relationships that existed prior to the surgical decompression.

show abstract

“…[1][2][3][4][5][6][7][8][9][11][12][13][14][15][16][17][18][19][65][66][67]70,71,100,[102][103][104][105][106][107][108][109][110][111][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][132]…”

Section: General Informationunclassified

“…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

View full text Add to dashboard Cite

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.

show abstract

Surgical prognosis in hindbrain related syringomyelia

Cited by 24 publications

References 47 publications

Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation

Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation

Acute respiratory arrest following partial suboccipital cranioplasty for cerebellar ptosis from Chiari malformation decompression

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

Contact Info

Product

Resources

About