When Is Duraplasty Required in the Surgical Treatment of Chiari Malformation Type I Based on Tonsillar Descending Grading Scale?

Yılmaz, Adem; Kanat, Ayhan; Müslüman, Ahmet Murat; Çolak, İbrahim; Terzi, Yüksel; Kayacı, Selim; Aydın, Yunus

doi:10.1016/j.wneu.2010.09.005

Cited by 71 publications

(49 citation statements)

References 27 publications

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“…Yilmaz et al classified cerebellar tonsillar descent (CTD) as grade I (the tonsil descended more than 5 mm below the foramen magnum but did not reach the C1 arch), grade II (the tonsil reached the C1 arch) and grade III (the tonsil descended below the C1 arch) (30). There were no statistically significant differences between preoperative and postoperative size of the syrinx cavity and rate of improvement in the duraplasty and non-duraplasty groups in CTD grade I and II, but in CTD grade III, the decrease in size of the syrinx cavity and clinical improvement were statistically significantly better in the duraplasty group.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

Gürbüz¹,

Karaaslan²,

Çalışkan³

et al. 2014

Turkish Neurosurgery

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AIM:The surgical results for foramen magnum decompression (FMD) with and without duraplasty in Chiari Malformation type 1 (CM-1) were compared retrospectively. MATErIAL and METHods:Thirty-nine cases of CM-1 with and without syringomyelia (SM) were included. There were 18 patients in the nonduraplasty and 21 in the duraplasty group. Syringomyelia, tonsillar herniation (TH), preoperative symptom duration, and postoperative SM size were compared. rEsuLTs: No significant difference was found between improvement in the duraplasty group (81%) and the non-duraplasty group (61.1%). In cases whose symptom duration was 0-36 months, improvement in the duraplasty group (93%) was significantly better than in the nonduraplasty group (50%) (p<0.01). The rate of syrinx regression was 92.3% in the duraplasty group and 12.5% in the non-duraplasty group (p<0.05). In cases with SM, the improvement was 21.4% in the non-duraplasty group compared to 78.6% in the duraplasty group (p=0.056). In cases with TH greater than 10 mm, the improvement was 66.7% in the non-duraplasty group, whereas all six cases (100%) in the duraplasty group had improved. CoNCLusIoN:In SM associated cases, cases with TH greater than 10 mm, and whose symptom duration is less than 36 months, duraplasty is a more reliable choice despite a slightly higher rate of complications. BuLGuLAr: Duraplastili (%81) ve duraplastisiz grubun (%61,1) iyileşme oranları arasında anlamlı fark bulunmadı. Preoperatif semptom süresi 0-36 ay arasında olan olgularda; duraplastili grubun iyileşme oranı (%93) duraplastisiz gruba göre (%50) anlamlı oranda yüksekti (p<0.05). Sirenks boyutunda küçülme oranı duraplastili grupta % 92,3 iken duraplastisiz grupta % 12.5 idi (p<0.05). SM bulunan olgularda; duraplastili grubun iyileşme oranı % 78,6, duraplastisiz grubun iyileşme oranı ise % 21,4 idi (p=0.056). TH'un 10 mm'den fazla olduğu olgularda; duraplastisiz grubun iyileşme oranı % 66,7 iken, duraplastili 6 olgunun tamamı iyileşmişti (%100).soNuÇ: SM'li olgularda, TH'un 10 mm'den fazla olduğu olgularda ve semptom süresi 36 aydan kısa olan olgularda duraplasti hafif yüksek komplikasyon oranı olmakla birlikte daha iyi bir seçenek olarak düşünülmüştür.

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Section: Discussionmentioning

confidence: 99%

“…Yılmaz et al (30) classified the amount of tonsillar herniation (TH) according to the spatial relationship between the herniated tonsils and the posterior arch of C1. As a simpler method, we classified the TH according to the length (mm) of tonsillar descent from the foramen magnum as either 5-10 mm or 10-20 mm.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

Gürbüz¹,

Karaaslan²,

Çalışkan³

et al. 2014

Turkish Neurosurgery

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“…These satisfactory neurological results in approximately three-quarters of all patients correspond with the similarly good improvement/resolution of syrinx. [154][155][156][157][158][159] However, only 16% of these series reported postoperative headache outcomes. As the other aspects of postoperative results showed, the improvement or resolution of headaches was also good, occurring in 73% of adult patients, 88% of pediatric patients, and 81% in all patients (Fig.…”

Section: Postoperative Outcomes: Neurological Statusmentioning

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

202

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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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“…4 Another study of 82 adult patients by Yilmaz et al reported that in cases where Chiari Type I malformation involved Grade 3 cerebellar tonsillar descent (tonsils descend over C-1 arch), dural opening with duraplasty resulted in significantly greater resolution of syrinx and clinical improvement. 17 Based on this knowledge, we hypothesized that bone-only decompression, which precludes tonsillar cautery, may be responsible for the bivariate association of tonsillar cautery with decreased number of repeat decompressions. In our multivariate logistic linear regression to control for possible confounders, we found that bone-only decompression independently predicted an increase in the need for repeat decompression.…”

Section: Tonsillar Cautery and Repeat Decompressionsmentioning

confidence: 99%

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

Stanko¹,

Lee²,

Rios³

et al. 2016

PED

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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.

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When Is Duraplasty Required in the Surgical Treatment of Chiari Malformation Type I Based on Tonsillar Descending Grading Scale?

Cited by 71 publications

References 27 publications

Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

Comparison of the surgical results for foramen magnum decompression with and without duraplasty in chiari malformation type 1

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

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

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