Swallowing Disorders in Patients with Chiari Malformation Type I After Decompression Neurosurgery

Abstract

OBJECTIVE: The present study aimed to investigate postoperative swallowing disorders in patients diagnosed with CM I after decompression neurosurgery. METHODS: We selected 54 patients after decompression neurosurgery procedure for CM I from January 2017 to December 2019. We evaluated the speech-language assessment (CSLSA) 24-hours after postsurgical extubation. CSLSA observed aspects of posture, sensitivity, tone, and extra-and intraoral mobility of the FAO and visualizing the functions of breathing, phonation, articulation, chewing, and swallowing. We correlated the severity of the dysphagia and the presence of associated malformations in the CM I patients.RESULTS: In our study, 39 patients were female (mean age 41.3±47.1 years). Thirty-seven patients had associated malformations (p=0.0243): 21 patients syringomyelia, 11 basilar invagination and 5 syringomyelia and basilar invagination. Dysphagia was present in 37 of the cases (68.5%;p=0.0016).Dysphonia in 13 (24.1%;p=0.4785) and dysarthria in 3 (5.6%;p=0.0042). We observed in the CSLSA: orofacial hypomobility (29-patients-53.7%;p=0.0204), orofacial hyposensitivity (26-patients-48.1%; p=0.3023), reduced GAG re ex (24 patients-44.5%;p=0.1041), ineffective cough (19 patients-35.2%;p=0.0022), ineffective saliva swallowing (18-patients-33.3%;p=0.0396), dyspnea (13-patients-24.1%;p=0.4785), orofacial hypotonia (11-patients-20.4%;p=0.0004), altered cervical auscultation (10-patients-18.5%;p=0.0003), and dysarthria (3-patients-9.3%;p=0.0042). The presence of associated malformations signi cantly in uenced the appearance of swallowing disorders, the severity of oropharyngeal dysphagia, the post-surgical complications (17-patients-31.5%;p<0.001), and the clinical outcomes (p=0.0029) of patients with CM type I.CONCLUSION: Decompressive neurosurgery for CM I had low rates of post-surgical complications overall.However, there was a high incidence of dysphagia. The presence of associated malformations is related with poorer prognosis and greater severity of oropharyngeal dysphagia in patients with CM I. rehabilitation and symptomatic improvement. However, given assessments of symptomatic improvement in these patients are heterogeneous, interest in developing validated standardized measures and scales to assess symptomatology after decompressive neurosurgery in CM I patients has increased. 6,7,8,9 Dysphagia is one of the most common symptoms. 10,11,12 Severe dysphagia may result in tracheal dysphagia, leading to pulmonary infections, malnutrition, prolonged hospital length of stay, and death. 13 At our center, CM I patients are managed with a multidisciplinary team including physiotherapist, nurse, occupational therapist, psychologist, and a speech therapist preoperatively and postoperatively. The speech therapist evaluates, diagnoses, and rehabilitates de cits in phonoarticulatory organs (FAO) and the stomatognathic functions such as breathing, sucking, chewing, swallowing, phonation, and articulation. For patients with dysphagia, the speech therapist suggests dietary modi c...