A Systematic Review of Chiari I Malformation: Techniques and Outcomes

Zhao, Jian‐Lan; Li, Meihua; Wang, Chunliang; Wang, Meng

doi:10.1016/j.wneu.2015.11.087

Cited by 99 publications

(65 citation statements)

References 21 publications

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“…In patients with CM-I and syrinx, most experts recommend performing durotomy and duraplasty, as this allows microscopic inspection and lysis of arachnoid bands that may be responsible for the syrinx. 12 However, there is controversy as to whether duraplasty is necessary, particularly in the absence of a syrinx, and many authors perform bone-only decompressions to reduce the risks associated with duraplasty. A multicenter randomized trial is underway to address this.…”

Section: Discussionmentioning

confidence: 99%

Intracranial hypertension following sacrifice of occipital and marginal sinuses during posterior fossa decompression for Chiari I malformation: case report

Champagne¹,

Cayouette

Lortie

et al. 2018

Journal of Neurosurgery: Pediatrics

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The occipital and marginal sinuses, when present, must be sacrificed in order to open the dura in most posterior fossa surgeries in the pediatric population, including posterior fossa decompression for Type I Chiari malformation (CM-I) with duraplasty. Apart from the immediate risk of hemorrhage, the voluntary occlusion of this structure is almost universally well tolerated. The authors report a case of intracranial hypertension following the sacrifice of occipital and marginal sinuses following posterior fossa decompression with duraplasty for CM-I. The specific draining pattern variant of the occipital and marginal sinuses leading to this complication as well as avoidance and management strategies of this condition are discussed.

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Section: Discussionmentioning

confidence: 99%

Intracranial hypertension following sacrifice of occipital and marginal sinuses during posterior fossa decompression for Chiari I malformation: case report

Champagne¹,

Cayouette

Lortie

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…This notion is also supported by Zhao JL et al, who did a meta-analysis of 18 articles which included a total of 1242 patients. 12 However, there is a subset of patients who showed clinical improvement in the non duraplasty group as well. This was seen particularly in symptoms like neck pain (80% of the patients showed improvement).…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome following duraplasty in type 1 Arnold Chiari malformation

Bettaswamy¹,

Raykar²,

Singh³

et al. 2019

Int Surg J

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Background: Few authors support the use of duraplasty and few authors have reported a higher rate of complications associated with the same. The objective of the present endeavor was to study clinical outcome following duraplasty in type 1 Arnold Chiari malformation.Methods: Retrospectively, 24 cases and prospectively 18 cases diagnosed and operated for Chiari malformation type I were included. Patients with Chiari type II, III, and IV were excluded. A questionnaire was used to assess the improvement in neck pain and disability due to it, head pain and disability due to it and improvement in general health before and one year after surgery. The results of the questionnaire of both groups were analyzed and compared.Results: The most common age group of presentation was 2nd decade (35.71%) followed by 3rd decade (26.19%). The male to female ratio was 1.2:1. The most common presenting complaint was sensory disturbances (66.66%) followed by neck pain in 14 patients (33.33%). The most common sign was limb weakness in 21 patients (50%). 24 patients were operated with foramen magnum decompression with duraplasty and 18 patients were operated without duraplasty. There were more complications in the duraplasty group. Patients showed an overall clinical improvement of 83.33% in the duraplasty group compared to a lower overall clinical improvement rate of 55.50% in the no duraplasty group. Specific symptoms like neck pain showed similar rate of improvement of (88.89%) in the duraplasty group compared to no duraplasty group (80%).Conclusions: Foramen magnum decompression with duraplasty is superior to foramen magnum decompression without duraplasty although slightly higher rate of complication is seen with duraplasty.

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“…The genesis of hydrocephalus in cases of CM is complex and probably multifactorial [1][2][3][4][5][6][7] . Relief of hydrocephalus in our patient suggests that the overcrowding of the posterior fossa structures contributed to the genesis of hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

“…The association between hydrocephalus and Chiari malformation (CM) has not been described frequently. Ventricular dilation affects 7% to 10% of patients with CM but the ideal choice of surgical treatment is controversial [1][2][3][4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Improvement of Hydrocephalus in Patients with Chiari Malformation After Posterior Fossa Decompression

Heringer¹,

Oliveira²,

Sousa³

et al. 2018

jbnc

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Introduction. The association between hydrocephalus and Chiari malformation (CM) has not been described frequently. Ventricular dilation affects 7% to 10% of patients with CM, but the ideal choice of surgical treatment is controversial. We report a case of a patient with Chiari malformation and hydrocephalus with improvement in clinical symptoms and ventricular dilatation. Case Description. A 19-year-old male complaining of frontal headache when coughing, laughing and during valsalva maneuvers, associated with dizziness for 2 months. Magnetic resonance (MR) showed hydrocephalus and small posterior fossa with overcrowding of contents, characterizing Chiari malformation type I, with cerebellar tonsils protruding through magnum foramen. Patient underwent surgery with posterior fossa decompression in a semi-sitting position and removal of the arc C1. After 3 months of follow-up, headache disappeared becoming asymptomatic. Control MR showed improvement of hydrocephalus with restoration of the cisterna magna and CSF flow. Discussion. Hydrocephalus has been related to CM for a long time. In our case, we performed treatment with intradural and intra-arachnoidal approach with bilateral tonsillectomy without placing ventricular shunt. The cisterna magna was "recreated". There was improvement of hydrocephalus with decreased Evans ratio index and symptoms disappearance. Although there is no other studies addressing such matter, in this case, the improvement suggests that the CSF compression at the foramen magnum was the cause of associated hydrocephalus with Chiari malformation. RESUMO Introdução.A associação entre hidrocefalia e malformação de Chiari (CM) não foi descrita com frequência. A dilatação ventricular afeta 7% a 10% dos pacientes com CM, mas a escolha ideal do tratamento cirúrgico é controversa. Relatamos um caso de um paciente com MC e hidrocefalia com melhora nos sintomas clínicos e dilatação ventricular após tratamento. Descrição do caso. Homem de 19 anos queixando-se de cefaleia frontal durante tosse, riso e manobra de Valsalva, associado a tonturas por 2 meses. A ressonância magnética (RM) mostrou hidrocefalia e fossa posterior pequena, caracterizando a malformação de Chiari tipo I, com tonsilas cerebelares protraindo através do forame magno. Paciente submetido a cirurgia com descompressão da fossa posterior em posição semi-sentada e remoção do arco de C1. Após 3 meses de acompanhamento houve desaparecimento de cefaleia, tornando-se assintomático. A RM controle mostrou melhora da hidrocefalia com restauração da cisterna magna e fluxo de LCR. Discussão. A hidrocefalia tem sido relacionada a CM há muito tempo. No nosso caso, realizamos tratamento com abordagem intradural e intra-arachnoidal com amigdalectomia bilateral sem colocação de shunt ventricular. A cisterna magna foi recriada. Houve melhora da hidrocefalia com diminuição do índice de Evans e desaparecimento dos sintomas. Embora não haja outros estudos abordando essa questão, neste caso, a melhora sugere que a compressão do LCR no forame magno foi a caus...

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A Systematic Review of Chiari I Malformation: Techniques and Outcomes

Cited by 99 publications

References 21 publications

Intracranial hypertension following sacrifice of occipital and marginal sinuses during posterior fossa decompression for Chiari I malformation: case report

Intracranial hypertension following sacrifice of occipital and marginal sinuses during posterior fossa decompression for Chiari I malformation: case report

Clinical outcome following duraplasty in type 1 Arnold Chiari malformation

Improvement of Hydrocephalus in Patients with Chiari Malformation After Posterior Fossa Decompression

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