Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

Bao, Changshun; Liu, L.; Wang, B.; Xia, Xun; Gu, Yingjiang; Li, D.J.; Zhan, Shu-liang; Chen, G.L.; Yang, Fubing

doi:10.4238/2015.february.3.2

Cited by 18 publications

(12 citation statements)

References 17 publications

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“…All studies were published in peer-reviewed journals between 1995 and 2019. All but 1 study 24 involved a single institution, 22 studies were retrospective, 1-6,8, 10, 12-17, 19-23, 25-27 5 were prospective, 7,9,11,18,24 8 included both pediatric and adult patients, 1,2,9,13,15,20,24,26 and 9 included only pediatric patients. 3,4,14,17,18,21,23,25,27 The mean patient age across 25 studies (ages were not provided for 2 studies) was 25.8 ± 13.3 years (range 9-42.3 years).…”

Section: Included Studies and Patientsmentioning

confidence: 99%

Outcomes for various dural graft materials after posterior fossa decompression with duraplasty for Chiari malformation type I: a systematic review and meta-analysis

Yahanda

Simón

Limbrick

2021

Journal of Neurosurgery

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OBJECTIVE Posterior fossa decompression with duraplasty (PFDD) is often used for Chiari malformation type I (CM-I), but outcomes associated with different dural graft materials are not well characterized. In this meta-analysis, the authors examined complication rates and outcomes after PFDD for CM-I for autografts and four types of nonautologous grafts. METHODS A literature search of numerous electronic databases (Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database, and ClinicalTrials.gov) was performed to identify articles detailing complications for dural graft materials after PFDD. Whenever available, data were also extracted regarding the need for revision surgery, symptom changes after PFDD, and syrinx size changes after PFDD. All searches were compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Institute of Medicine, Standards for Systematic Reviews, Cochrane Handbook for Systematic Reviews of Interventions, and Peer Review of Electronic Search Strategies guidelines. There were no exclusion criteria based on patient age or presence or absence of syringomyelia. RESULTS The current evidence surrounding outcomes for various dural graft materials was found to be of low or very low quality. Twenty-seven studies were included, encompassing 1461 patients. Five types of dural graft materials were included: autograft (n = 404, 27.6%), synthetic (n = 272, 18.6%), bovine pericardium (n = 181, 12.4%), collagen-based (n = 397, 27.2%), and allograft (n = 207, 14.2%). Autograft was associated with a significantly lower rate of pseudomeningocele compared to collagen-based grafts, allografts, and nonautologous grafts in aggregate. Autograft was also associated with the lowest rates of aseptic meningitis, infectious meningitis, and need for revision PFDD, though these associations did not reach statistical significance. No other graft comparisons yielded significant results. Autograft and nonautologous graft materials yielded similar rates of revision surgery and produced similar improvements in postoperative symptoms and syrinx size. CONCLUSIONS Autograft was the dural graft material that most frequently had the lowest rate of complications and was associated with significantly lower rates of pseudomeningocele compared to collagen-based graft, allograft, and nonautologous graft materials. Autografts and nonautologous grafts yielded similar outcomes for revision surgery, symptoms, and syrinx size. Large prospective studies comparing different graft materials are needed to accurately and precisely characterize outcomes for individual graft types.

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Section: Included Studies and Patientsmentioning

confidence: 99%

Outcomes for various dural graft materials after posterior fossa decompression with duraplasty for Chiari malformation type I: a systematic review and meta-analysis

Yahanda

Simón

Limbrick

2021

Journal of Neurosurgery

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“…Advocates of tonsillar reduction consider it a safe procedure that ensures optimal expansion of the foramen magnum and patency of the CSF pathways with a low complication rate. 2,4,12,18,23,31 In fact, some surgeons favor tonsillar resection with minimal bony decompression. 3,18 It is presumed that because chronic compression renders the tonsils atrophic and gliotic, 10,20 removing them adds no neurological injury.…”

Section: Pros and Cons Of Tonsillar Reductionmentioning

confidence: 99%

Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study

Koueik

Sandoval-Garcia

Kestle

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEDespite significant advances in diagnostic and surgical techniques, the surgical management of Chiari malformation type I (CM-I) with associated syringomyelia remains controversial, and the type of surgery performed is surgeon dependent. This study’s goal was to determine the feasibility of a prospective, multicenter, cohort study for CM-I/syringomyelia patients and to provide pilot data that compare posterior fossa decompression and duraplasty (PFDD) with and without tonsillar reduction.METHODSParticipating centers prospectively enrolled children suffering from both CM-I and syringomyelia who were scheduled to undergo surgical decompression. Clinical data were entered into a database preoperatively and at 1–2 weeks, 3–6 months, and 1 year postoperatively. MR images were evaluated by 3 independent, blinded teams of neurosurgeons and neuroradiologists. The primary endpoint was improvement or resolution of the syrinx.RESULTSEight clinical sites were chosen based on the results of a published questionnaire intended to remove geographic and surgeon bias. Data from 68 patients were analyzed after exclusions, and complete clinical and imaging records were obtained for 55 and 58 individuals, respectively. There was strong agreement among the 3 radiology teams, and there was no difference in patient demographics among sites, surgeons, or surgery types. Tonsillar reduction was not associated with > 50% syrinx improvement (RR = 1.22, p = 0.39) or any syrinx improvement (RR = 1.00, p = 0.99). There were no surgical complications.CONCLUSIONSThis study demonstrated the feasibility of a prospective, multicenter surgical trial in CM-I/syringomyelia and provides pilot data indicating no discernible difference in 1-year outcomes between PFDD with and without tonsillar reduction, with power calculations for larger future studies. In addition, the study revealed important technical factors to consider when setting up future trials. The long-term sequelae of tonsillar reduction have not been addressed and would be an important consideration in future investigations.

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“…Symptoms such as sensory disorders and motor dysfunctions in limbs, and gatism, which were similar to the clinical manifestations of disc herniation, were common in cervical spinal canal tumor and chiari malformation, so it was a reason to make misdiagnosis. [12][13] In this group of data, 16 cases were missed diagnosis and misdiagnosed in the external hospital, 5 cases were wrong operation in the external hospital, and 3 cases were missed and misdiagnosed in other departments of our hospital, and 1 case was misoperation. The reasons for misdiagnosis were analyzed as follows.…”

Section: Discussionmentioning

confidence: 72%

Clinical Analysis of Primary Thoracic and Lumbar Intraspinal Tumors Misdiagnosed as Lumbar Intervertebral Disc Herniation: Report of 19 Cases

Luo¹,

Yang²,

Yu³

et al. 2019

IJCMR

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Introduction:Intraspinal tumors were primary and secondary tumors that occurred in the spinal cord, nerve roots, meninges and the tissue of the wall of vertebral canal. Study aimed to analyze the misdiagnosis causes of intraspinal tumors misdiagnosed as lumbar intervertebral disc herniation, and to reduce the rate of clinical misdiagnosis. Material and Methods:Clinical data of 19 patients with intraspinal tumors misdiagnosed as lumbar intervertebral disc herniation were retrospectively analyzed, and the respective characteristics, essentials for diagnosis and differential diagnosis of the two different kinds of diseases were summarized. The misdiagnosis causes were analyzed, and the prevention measures were put forward. Results:All the misdiagnosed patients' data on MRI were collected, and then they received operative treatment. Histological diagnosis results showed that there were 13 cases of schwannomas, 3 cases of meningiomas, 2 cases of ependymomas, and 1 case of angiomyolipoma. In 1~36 months' follow-up, pain of all the patients was alleviated. Eighteen patients were healed, and only one patient still felt numbness at left hip and left leg. No patient reoccurred or died. Conclusion:Though there were similarities in early clinical manifestations between intraspinal tumors and lumbar intervertebral disc herniation, these two different kinds of diseases can be identified by collecting the case history detailedly, performing physical examination carefully, and choosing the imaging examination appropriately to avoid misdiagnosis.

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Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia

Cited by 18 publications

References 17 publications

Outcomes for various dural graft materials after posterior fossa decompression with duraplasty for Chiari malformation type I: a systematic review and meta-analysis

Outcomes for various dural graft materials after posterior fossa decompression with duraplasty for Chiari malformation type I: a systematic review and meta-analysis

Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study

Clinical Analysis of Primary Thoracic and Lumbar Intraspinal Tumors Misdiagnosed as Lumbar Intervertebral Disc Herniation: Report of 19 Cases

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