The evaluation of surgical treatment options in chiari malformation type i

Erdoğan, Ersin; Cansever, Tufan; Seçer, Halil İbrahim; Temız, Cüneyt; Şirin, Sait; Kabataş, Serdar; Gönül, Engin

doi:10.5137/1019-5149.jtn.2648-09.2

Cited by 31 publications

(44 citation statements)

References 28 publications

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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

190

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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

190

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“…The diagnosis of CMI is made using neuro-imaging technique, and the preferred technique is magnetic resonance imaging (MRI) (1,5). Clinical symptoms may either develop in a slow process through the clinical years or acutely because of trauma (2,7,8). If the patient shows any clinical symptoms, surgical treatment is recommended.…”

Section: Introductionmentioning

confidence: 99%

Chiari Malformation Type 1 Associated with Syringomyelia Which Clinical Symptoms Occuring during Tooth Extraction

Ulutabanca¹,

Küçük²,

Tümtürk³

et al. 2015

Erciyes Med J

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Chiari Malformation type 1 (CMI) is a congenital anomaly of the hindbrain, in which cerebellar tonsils herniate into the spinal canal. A 47-year-old male patient, who never had an additional disease up to that time sat on a dentist's chair for approximately half an hour with his neck extended for a tooth extraction. While getting up from the chair, the patient developed clinical symptoms. CMI may be undetected for years. Clinical symptoms may have appeared because of keeping the neck in the flexion or extended position for a very long duration of time.

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“…More frequent in females, it usually causes symptoms in third and fourth decades, and it is also called as the "adult form". [1,3,6,[8][9][10][11][12] Although there are a number of hypotheses proposed, its etiology is still not clear. These hypotheses include bony malformation at the craniocervical junction, small posterior fossa cranial defects caused by hypoplasia of the basilar part of the occipital bone or platybasia, vertebral defects, traction, and primary mesodermal insufficiency.…”

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confidence: 99%

“…Chiari type I is the caudal herniation of cerebellar tonsils through foramen magnum by no more than 3 or 5 mm. [1,3,4,6,7,[9][10][11] In Chiari type II, there is a caudal herniation of the brainstem and the fourth ventricle into upper cervical canal through foramen magnum, frequently associated with myelomeningocele, and rarely associated with spina bifida occulta. Chiari type III is the most severe form in which posterior fossa structures herniate into an occipitocervical meningocele sac.…”

mentioning

confidence: 99%

“…Those symptoms may be non-specific such as headache, neck pain, vertigo, tinnitus, fatigue and paresthesia of the extremities, or may be specific such as trigeminal neuralgia, hearing loss, glossopharyngeal neuralgia and autonomic nervous system findings and the patients might be misdiagnosed. [1,3,5,7,9,10] Formation of CSF cavities in spinal cord is called syringomyelia, the most common disorder accompanying Chiari malformation. Syringomyelia was reported in 40-76% of patients with Chiari type I.…”

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confidence: 99%

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Prevalence of Chiari type I malformation on cervical magnetic resonance imaging: a retrospective study

Oktem¹,

Dilli²,

Kürkçüoğlu³

et al. 2016

Anatomy

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Chiari malformation, also known as Arnold-Chiari malformation, is characterized by the caudal herniation of posterior fossa structures through the foramen magnum into the cervical spinal canal. It is a congenital malformation of the craniovertebral junction and hindbrain often associated with other abnormalities of the cerebrospinal axis. [1][2][3][4][5][6][7][8] Chiari malformation is classically classified into four types. Chiari type I is the caudal herniation of cerebellar tonsils through foramen magnum by no more than 3 or 5 mm. [1,3,4,6,7,[9][10][11] In Chiari type II, there is a caudal herniation of the brainstem and the fourth ventricle into upper cervical canal through foramen magnum, frequently associated with myelomeningocele, and rarely associated with spina bifida occulta. Chiari type III is the most severe form in which posterior fossa structures herniate into an occipitocervical meningocele sac. Severe cerebellar hypoplasia in absence of cerebellar herniation is observed in Chiari type AbstractObjectives: Chiari malformation is characterized by caudal herniation of cerebellar tonsils from foramen magnum into the cervical canal on radiological images. Type I Chiari malformation is the herniation of cerebellar tonsils more than 3 mm which does not cause any symptoms until adulthood. In this study, we aimed to investigate the prevalence of Chiari type I malformation. Methods:In this retrospective study, cervical magnetic resonance images taken between 2013 and 2015 were retrospectively analyzed. The patients were 18-70 year old males and females. Type I Chiari malformation was defined as an inferior displacement of the cerebellar tonsils more than 3 mm below the opisthion-basion line. The patients with intracranial lesions, hydrocephalus or previous craniotomy were excluded from the study. Results:The prevalence of Chiari type I malformation was found as 4% when both genders were taken into consideration. The prevalence was 3.3% in females and 0.7% in males. Chiari type I malformation was associated with syringomyelia in 0.5% of females and 0.2% of males. In the present study, concomitant syringomyelia was observed in 0.7% of the patients. On the other hand, incidence of Chiari type I malformation was found relatively higher in the patients with scoliosis (15.4%). The ratio of this co-occurrence was higher in females (11.4%) when compared to the males (4%). Conclusion:In the present study, the prevalence of Chiari type I malformation was investigated in a large population, consisting of 2480 individuals, and its association with syringomyelia and scoliosis.

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The evaluation of surgical treatment options in chiari malformation type i

Abstract: Almost the same clinical outcomes can be achieved with and without duroplasty. There might be an option to perform duroplasty if simple procedure fails.

Cited by 31 publications

References 28 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

Chiari Malformation Type 1 Associated with Syringomyelia Which Clinical Symptoms Occuring during Tooth Extraction

Prevalence of Chiari type I malformation on cervical magnetic resonance imaging: a retrospective study

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