The first posterior fossa decompression for Chiari malformation: the contributions of Cornelis Joachimus van Houweninge Graftdijk and a review of the infancy of “Chiari decompression”

Mortazavi, Martin M.; Tubbs, R. Shane; Hankinson, Todd C.; Pugh, Jeffrey A.; Cohen-Gadol, Aaron; Oakes, W. Jerry

doi:10.1007/s00381-011-1421-1

Cited by 16 publications

(4 citation statements)

References 14 publications

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“…Much has been written about the history of CIM and the development in understanding through the years, regarding the nature of this condition. 35,44,45,52 As recently as the 1970s, standard neurology texts did not mention CIM and grouped syringomyelia in the degenerative section. 41 Surgery was thought to have no value at the time and radiation therapy is instead noted as a treatment option.…”

Section: Background and Historical Contextmentioning

confidence: 99%

The Chiari I malformation

McClugage¹,

Oakes²

2019

Journal of Neurosurgery: Pediatrics

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As with many pathologies, the course of our understanding of the Chiari I malformation (CIM) has developed extensively over time. The early descriptions of the Chiari malformations by Hans Chiari in 1891 opened the door for future classification and research on this topic. However, even over a long timeframe, our understanding of the pathophysiology and, more importantly, treatment, remained in its infancy. As recently as the 1970s, CIM was not discussed in popular neurology textbooks. Syringomyelia is listed as a degenerative disorder with no satisfactory treatment. Radiation therapy was considered an option in treatment, and surgery was thought to play no role. During the last 40 years, equivalent to the duration of a neurosurgical career, our understanding of the pathophysiology and natural history of CIM, coupled with modern MRI, has improved the treatment paradigm for this patient population. More importantly, it has given us evidence confirming that CIM is a disorder responsive to surgical intervention, giving patients once thought to be destined for lifelong disability a comparatively normal life after treatment. The purpose of this article is to offer a review of CIM and its important associated entities. The authors will discuss the evolution in understanding of the Chiari malformation and, importantly, distinguish between symptomatic CIM and asymptomatic tonsillar ectopia, based on imaging and presenting symptomatology. They will discuss techniques for surgical intervention, expected outcomes, and complications after surgery. Proper patient selection for surgery based on appropriate symptomatology is tantamount to achieving good surgical outcomes in this population, separating those who can be helped by surgery from those who are unlikely to improve. While our knowledge of the Chiari malformations continues to improve through the efforts of clinical and basic science researchers, surgeons, and patients, our current understanding of these entities represents a monumental improvement in patient care over a relatively short time period.

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Section: Background and Historical Contextmentioning

confidence: 99%

The Chiari I malformation

McClugage¹,

Oakes²

2019

Journal of Neurosurgery: Pediatrics

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“…Posterior fossa decompression (PFD) for CM-I was first described in 1930 30 and has continued to serve as the primary treatment for children and adults with symptoms referable to the malformation and severe enough to warrant surgical intervention. 2,5–8,11–13,15,20,22,26,33,34,39,41 …”

Section: To the Editormentioning

confidence: 99%

Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I

Kennedy

Kelly

Phan

et al. 2015

PED

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OBJECT Symptomatic pediatric Chiari malformation Type I (CM-I) is most often treated with posterior fossa decompression (PFD), but controversy exists over whether the dura needs to be opened during PFD. While dural opening as a part of PFD has been suggested to result in a higher rate of resolution of CM symptoms, it has also been shown to lead to more frequent complications. In this paper, the authors present the largest reported series of outcomes after PFD without dural opening surgery, as well as identify risk factors for recurrence. METHODS The authors performed a retrospective review of 156 consecutive pediatric patients in whom the senior authors performed PFD without dural opening from 2003 to 2013. Patient demographics, clinical symptoms and signs, radiographic findings, intraoperative ultrasound results, and neuromonitoring findings were reviewed. Univariate and multivariate regression analyses were performed to determine risk factors for recurrence of symptoms and the need for reoperation. RESULTS Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up (mean 32 months). There were no major complications. The mean length of hospital stay was 2.0 days. In a multivariate regression model, partial C-2 laminectomy was an independent risk factor associated with reoperation (p = 0.037). Motor weakness on presentation was also associated with reoperation but only with trend-level significance (p = 0.075). No patient with < 8 mm of tonsillar herniation required reoperation. CONCLUSIONS The vast majority (> 90%) of children with symptomatic CM-I will have improvement or resolution of symptoms after a PFD without dural opening. A non–dural opening approach avoids major complications. While no patient with tonsillar herniation < 8 mm required reoperation, children with tonsillar herniation at or below C-2 have a higher risk for failure when this approach is used.

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“…The first report of surgery for CM was in the year 1932 when Van Houweninge Graftidijik reported his attempt to correct the deformity. [ 23 ] He performed removal of posterior fossa bone, opening of the dura, and resection of the redundant tissue. The surgery was aimed at relieving the obstruction of CSF flow.…”

Section: Confusion In Managementmentioning

confidence: 99%

Chiari malformation: Has the dilemma ended?

Shah¹,

Dhar

Elsanafiry³

et al. 2017

J Craniovert Jun Spine

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Chiari malformation as a clinical entity has been described more than hundred years ago. The concepts regarding pathogenesis, clinical features and management options have not yet conclusively evolved. Considering that a variety of treatment methods are being adopted to treat Chiari malformation is suggestive of the fact that confusion still reigns supreme in the minds of treating clinicians. Over the years, the understanding of Chiari malformation has changed from a disease process to a natural protective phenomenon and the treatment from decompression to fixation.

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The first posterior fossa decompression for Chiari malformation: the contributions of Cornelis Joachimus van Houweninge Graftdijk and a review of the infancy of “Chiari decompression”

Cited by 16 publications

References 14 publications

The Chiari I malformation

The Chiari I malformation

Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I

Chiari malformation: Has the dilemma ended?

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