The impact of neurosurgical technique on the short- and long-term outcomes of adult patients with Chiari I malformation

Gallo, Pasquale; Copley, Phillip Correia; McAllister, S.; Kaliaperumal, Chandrasekaran

doi:10.1016/j.clineuro.2020.106380

Cited by 8 publications

(4 citation statements)

References 39 publications

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“…█ DISCUSSION Some meta-analyses and systematic reviews have suggested that PFDD is superior to PFD in terms of overall clinical improvement (13,25,41,47), while some studies have shown that PFDD is better at least for patients with syringomyelia (24). However, some systematic reviews have reported no significant difference between the two approaches (3,9,11,33).…”

Section: Syringomyelia Reductionmentioning

confidence: 99%

Comparison of foramen magnum decompression with and without duraplasty in the treatment of adult chiari malformation type i: a meta-analysis and systematic review

Chenghua¹,

Min²,

Li³

et al. 2022

Turkish Neurosurgery

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AIM:To include new relevant findings in a systematic review to provide the first comparison of foramen magnum decompression with duraplasty (PFDD) and without duraplasty (PFD) in adult Chiari malformation Type I (CM-I). MATERIAL and METHODS:We retrospectively searched Web of Science, PubMed, Embase and ClinicalTrials.gov to summarize all relevant published papers on adults. A systemic review was adopted to evaluate clinical or radiological improvement, surgical complications, and reoperation rates between the PFD and PFDD groups.RESULTS: Nine papers containing information on 497 adult participants met the criteria. PFDD was related to a lower revision rate (RR=2.96, 95% CI: 1.34-6.51, p=0.007) but a higher complication rate (RR=0.35, 95% CI: 0.22-0.55, p<0.00001). No significant difference was noted between PFD and PFDD in terms of overall symptom improvement (RR=0.93, 95% CI: 0.84-1.03, p=0.17) or syringomyelia reduction (RR=0.84, 95% CI: 0.63-1.12, p=0.24). No significant difference in symptom improvement was observed between patients with syringomyelia (RR=0.86, 95% CI: 0.69-1.08, p=0.20) and patients without syringomyelia (RR=0.94, 95% CI: 0.68-1. 30, p=0.73).CONCLUSION: This systematic review of observational studies reveals that PFDD may provide lower revision rates but pose a higher risk than PFD in the management of CM-I in adults. However, PFD is similar to PFDD in clinical and radiological improvements.

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Section: Syringomyelia Reductionmentioning

confidence: 99%

Comparison of foramen magnum decompression with and without duraplasty in the treatment of adult chiari malformation type i: a meta-analysis and systematic review

Chenghua¹,

Min²,

Li³

et al. 2022

Turkish Neurosurgery

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“…Moreover, even though what recent theories suggest a well-liked method for treatment for Chiari malformation, Variables like age, gender, presenting complaints, syrinx and post-operative outcome were noted. Chicago Chiari outcome scale was used to assess the 11,12 outcome. Data were entered and analyzed by using version 26.0 of the statistical package of social sciences (SPSS) software.…”

Section: Jduhsmentioning

confidence: 99%

Outcome of Posterior Fossa Decompression and Duroplasty in Adult Chiari Malformation

Kalhoro¹,

Sattar

Hashim³

2021

J Dow Univ Health Sci

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Early diagnosis is of utmost importance, so magnetic resonance imaging cervical spine is one of the prime diagnostic tools which helps in Documentation of cerebellar tonsils below the FM > 5 mm to an average of 12 mm. Available surgical options are cranial/cervical decompression, with/without fusion, and duraplasty or ABSTRACT Objective: To evaluate outcome of posterior fossa decompression and duroplasty in patients with Chiari Malformation 1 (CM1). Methods: This retrospective study was conducted at Neurospinal and Cancer Care Institute, Karachi, from March 2010 to March 2019. After diagnosis with the help of Magnetic Resonance Imaging (MRI) cervical spine, all patients with CM I, having headache, neck pain, limbs numbness and syringomyelia were included. Information was collected regarding demographic characteristics, presenting complaints, and post-operative outcome. Chicago Chiari outcome scale was used to assess the outcome. Results: Of 91 patients, the mean age of the patient was 31 ±6.7 years. There were 58 (63.7%) males and 33 (36.3%) females. C2 laminectomy was performed in 10 (11.0%) patients while C1 assimilation in 3 (3.3%) patients. Hydrocephalus was found in 12 (13.1%) patients. The outcome of posterior fossa decompression (PFD) showed that functional outcome was found higher, i.e., 46 (50.5%), followed by excellent outcome 25 (27.5%), impaired outcome 15 (16.5%), and incapacitated in 5 (5.5%). The comparison of outcome with baseline characteristics showed that most of the patients with age >30 years had excellent and functional outcome, i.e., 16 (28.1%) and 26 (45.6%) respectively. Five (8.6%) females had incapacitated outcome. Moreover, headache, syringomyelia, and swallowing difficulty were observed somewhat equal in each outcome. Conclusions: PFD surgery with duraplasty can improve the clinical symptoms. Decompressive surgery in patients with duraplasty can significantly improve the patient condition while late presentation may affect the clinical outcome.

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“…The decompression performed ventrally here is analogous to the nondural opening procedures, which are frequently highlighted in pediatric cohorts but are more controversial in efficacy in adult cohorts. [25][26][27][28] Several mechanisms have been proposed by which Chiari I malformations in adults may resolve without direct manipulation, including physiological changes in intracranial and intraspinal compartment pressures, atrophy of the cerebellar tonsils with age, and variations in position of the cerebellar tonsils with age. The resection of the chordoma may have relieved intracranial pressure, which made conditions more favorable for the cerebellar tonsils to return to a more normal configuration.…”

Section: Figure 5 Postoperative Imaging Findings Sagittal Ct Of the C...mentioning

confidence: 99%

Endoscopic Endonasal Resection of Cranio-Cervical Junction Chordoma and Ventral Chiari Decompression: A Case Report

Muthiah

McDowell

Zenonos

et al. 2021

ONSURG

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BACKGROUND Chiari I malformations secondary to other causes represent a small subset of presenting symptomatic cases. Typically, the primary cause of the malformation is addressed first and results in resolution of the malformation and symptoms. However, in some cases, a patient may present with both a primary Chiari I malformation and another unrelated neurosurgical lesions. OBJECTIVE To present a unique case in which resection of a ventral tumor allowed for spontaneous resolution of a simultaneously noted dorsal Chiari I malformation. METHODS Pertinent data, including presenting symptoms, hospital course, surgical notes, preoperative images, and postoperative images, were collected using the electronic medical record. RESULTS We present a case of a 46-yr-old man with a Chiari I malformation in conjunction with a ventral cranio-cervical junction chordoma. Endoscopic endonasal resection of the chordoma and ventral foramen magnum decompression resulted in radiographic resolution of the Chiari malformation and resolution of his symptoms. Our report represents a rare case of ventral foramen magnum decompression as a treatment for Chiari I malformation. CONCLUSION It is felt that the chordoma mass effect was not the source of the Chiari I malformation. Thus, both ventral and dorsal decompressions of the posterior fossa may be considered for Chiari I decompression in select circumstances.

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The impact of neurosurgical technique on the short- and long-term outcomes of adult patients with Chiari I malformation

Cited by 8 publications

References 39 publications

Comparison of foramen magnum decompression with and without duraplasty in the treatment of adult chiari malformation type i: a meta-analysis and systematic review

Comparison of foramen magnum decompression with and without duraplasty in the treatment of adult chiari malformation type i: a meta-analysis and systematic review

Outcome of Posterior Fossa Decompression and Duroplasty in Adult Chiari Malformation

Endoscopic Endonasal Resection of Cranio-Cervical Junction Chordoma and Ventral Chiari Decompression: A Case Report

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