Decompressive surgery for Chiari I malformation in children without dural repair: a still effective and safe procedure?

Kurzbuch, Arthur R.; Jayamohan, Jayaratnam; Magdum, Shailendra

doi:10.1007/s00381-019-04241-w

Cited by 16 publications

(15 citation statements)

References 37 publications

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“…However, previous studies clearly demonstrated clinical efficacy with decompression alone and probably remains a suitable treatment option for CM with no signs of instability [11,54]. In summary, we agree with Deora and colleagues that in patients with pure CM with symmetrical C1/2 joints and no signs of instability, PFD and duraplasty is an established, effective, and safe treatment option with excellent long-term outcome [18,28,62,89]. In patients with instability, C1-2 fusion with distraction or OCF with or without transoral decompression in selected cases are potential treatment options that have to be considered in this patient population.…”

Section: Chiari Malformation Type I-discussion Of Evidencesupporting

confidence: 68%

“…Several studies on long-term outcome provide testament to excellent results. Reported success rates reach 84% even after 5 years of follow-up as well as negligible surgical morbidity and mortality [28,62,88,89]. These results have to be opposed with the outcome of the novel C1-2 fixation strategy, for which long-term outcome is still sparse [33].…”

Section: Chiari Malformation Type I-discussion Of Evidencementioning

confidence: 99%

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Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

et al. 2020

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Introduction Recently, a novel hypothesis has been proposed concerning the origin of craniovertebral junction (CVJ) abnormalities. Commonly found in patients with these entities, atlantoaxial instability has been suspected to cause both Chiari malformation type I and basilar invagination, which renders the tried and tested surgical decompression strategy ineffective. In turn, C1-2 fusion is proposed as a single solution for all CVJ abnormalities, and a revised definition of atlantoaxial instability sees patients both with and without radiographic evidence of instability undergo fusion, instead relying on the intraoperative assessment of the atlantoaxial joints to confirm instability. Methods The authors conducted a comprehensive narrative review of literature and evidence covering this recently emerged hypothesis. The proposed pathomechanisms are discussed and contextualized with published literature. Conclusion The existing evidence is evaluated for supporting or opposing sole posterior C1-2 fusion in patients with CVJ abnormalities and compared with reported outcomes for conventional surgical strategies such as posterior fossa decompression, occipitocervical fusion, and anterior decompression. At present, there is insufficient evidence supporting the hypothesis of atlantoaxial instability being the common progenitor for CVJ abnormalities. Abolishing tried and tested surgical procedures in favor of a single universal approach would thus be unwarranted.

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Section: Chiari Malformation Type I-discussion Of Evidencesupporting

confidence: 68%

Section: Chiari Malformation Type I-discussion Of Evidencementioning

confidence: 99%

Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

et al. 2020

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“…[35][36][37][38][39] Surgery can be performed in either prone, concorde, semi-sitting, or even sitting position. 33,[40][41][42][43][44][45][46] The majority of authors prefer the prone position because this offers the comfort of the surgical team, and the risk of air embolism is minimal. We are generally in favor of sitting position for craniocervical junction interventions, as it offers a wide workspace, heightened spatial orientation, optimal venous drainage, decreased intracranial pressure, and adequate gravitational cerebellar traction.…”

Section: Discussionmentioning

confidence: 99%

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

Florian¹,

Pop²,

Florian

2021

Int J Clin Pract

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Objective: To present an alternative surgical technique in treating cases of Chiari I Malformation with mild-to-moderate syringomyelia after decompressive suboccipital craniectomy: incising only the outer layer of the dura mater, then dissecting it from the inner layer without opening the latter. Patients and methods:We utilized this technique in a short series of three cases who were admitted to our department for mild symptoms such as intermittent headache and dissociated sensory loss in the upper limbs, caused by a Chiari Malformation Type I. The patients were placed in the sitting position. We performed a reduced median suboccipital craniectomy and resection of the posterior arch of C1 adapted to the level of tonsil descent, from a limited superior half to complete resection. Afterward, we incised the outer dural layer, while sparing the inner one. Using a fine dissector, we then split apart the outer and inner layers to the margin of the craniectomy. Through the transparency of the inner layer and the arachnoid, the cerebellum and the medulla were visible and pulsating. An autologous fascia duraplasty was then performed. Results:The postoperative course was favorable in all cases, the patients being discharged without any deficits and with complete symptom resolution. Follow-up at 3, 6, and 12 months after surgery revealed a significant reduction in brainstem compression and syringomyelia. Conclusions:Interlayer dural split technique can be used effectively in treating symptomatic cases of type I Chiari malformation in adults, with mild-to-moderate syringomyelia. It is less invasive than opening the dura and possibly more effective than decompressive craniectomy and C1 laminectomy alone. This technique must be validated in a larger case-control series. Highlight s• Chiari 1 treatment involves the decompression of the foramen magnum via craniectomy, duraplasty, and resection of cerebellar tonsils.• These methods have varying success rates and there is much debate whether more or less invasive methods are required.• Our method aims to combine the invasive and less-invasive methods by only incising the outer layer of the dura mater, without entering into the subdural spaces, and performing a duraplasty to further prevent any CSF leakage.

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“…However, there are disagreements and wide range of variations regarding the extent of bone removal and different additional measures taken along with. For management of CM1, dura can be addressed in different ways like leaving the dura intact with removal of the constricting bands only [9], scoring of Role of Cranioplasty in Management of Chiari Malformation DOI: http://dx.doi.org /10.5772/intechopen.90055 the dura [10,11], resection of the outer layer of the dura [12][13][14], opening the dura and keeping it remain open [15][16][17], and performing duraplasty with different materials, both natural and artificial [13,[18][19][20][21][22][23][24]. The arachnoid manipulation equally differs from leaving it intact by doing an arachnoid preserving durotomy or arachnoid preserving duraplasty [9,[25][26][27], to opening and resecting it to remove adhesions [8,19,23,[28][29][30].…”

Section: Common Surgical Approaches For Chiari Malformationmentioning

confidence: 99%

Role of Cranioplasty in Management of Chiari Malformation

Rahman¹

2020

Neurosurgical Procedures - Innovative Approaches

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Chiari malformations (CM) are a set of enigmatic congenital anomalies, owing to their complex pathology, varied presentations and management dilemma. Because of the daunting nature of this disease, a universal definitive treatment protocol is yet to be established. Diverse surgical procedures are in practice with various philosophies, aiming to resolve different sections of the pathologies of this disorder, either singly or in combination. However, outcomes are quite variable. Though not a well-recognized and commonly practiced paradigm of managing CM, different techniques of cranioplasty for CM has been described by many authors with variable rates of success. Cranioplasty for Chiari has been found to be helpful in different circumstances with the objective to address different predicaments. Initially, it has been exercised as one of the modalities to manage some particular situations, mostly in cases to solve complications following surgery. Now in some centers, different types of methods of cranioplasty are practiced routinely to treat particular set of Chiari patients with specifically set criteria and some have shown success in those certain scenarios. In this chapter, different methods of cranioplasty for Chiari malformation by different authors, strategies behind the techniques and their results are described in brief. "Stealth cranioplasty", a technique devised by our team is also portrayed.

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Decompressive surgery for Chiari I malformation in children without dural repair: a still effective and safe procedure?

Cited by 16 publications

References 37 publications

Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

Role of Cranioplasty in Management of Chiari Malformation

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