Effects of Posterior Fossa Decompression with and without Duraplasty on Chiari Malformation-associated Hydromyelia

Munshi, Ilyas; Frim, David M.; Stine-Reyes, Roberta; Weir, Bryce; Hekmatpanah, Javad; Brown, Frederick D.

doi:10.1097/00006123-200006000-00018

Cited by 251 publications

(166 citation statements)

References 30 publications

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“…These findings are also referred to in the literature by several other authors 2,7,10,11,18,22,23,[27][28][29][30] .…”

Section: Discussionsupporting

confidence: 83%

“…Many others authors 3,8,18, 27 also used this position, although others prefered the prone position placement 2,10,[28][29][30][31][32] .…”

Section: Discussionmentioning

confidence: 99%

“…As to the cerebellar tonsils, some surgeons leave them intact, proceeding only with the opening of the fourth ventricle 31 29 have demonstrated that decompression of the posterior fossa plus laminectomy of C 1 and dural grafting for the treatment of CM yielded faster regression of the hydromyelia when compared to the decompression and laminectomy with no dural grafting. In order to avoid adherence of the graft to the cerebellum, Sahuquillo 31 (1994) used surgical stitches to be used on the graft with the porpose to move it away from the cerebellum and fixing it in the cervical aponeurosis.…”

Section: Discussionmentioning

confidence: 99%

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Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Silva¹,

Holanda

2003

Arq. Neuro-Psiquiatr.

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-The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The patients were divided into two groups. Group I (24 patients) underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients) underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation) in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior-caudal direction, avoiding, in this way, its adherence to the cerebellum. RESUMO -São analisados os resultados obtidos com o tratamento cirúrgico de 53 casos de impressão basilar (IB), malformação de Chiari (MC) e siringomielia (SM). Os pacientes foram divididos em dois grupos: no grupo I(24 casos) foi realizada a descompressão osteodural, caracterizada por craniectomia ampla occipital inferior, laminectomia variável de C 1 a C 3, abertura da dura-máter em forma de Y, dissecção das aderências aracnóideas das tonsilas cerebelares com o bulbo e medula cervical, abertura ampla do quarto ventrículo e enxerto dural; no grupo II (29 casos) foi utilizada a descompressão osteodural-neural, caracterizada pelos mesmos detalhes técnicos empregados no grupo I, acrescidos da tonsilectomia por amputação (10 casos) e por aspiração intrapial (19 casos). Nestes casos, o saco pial residual, resultante da aspiração intrapial das tonsilas cerebelares, foi suturado à dura-máter lateral e em posição cranial. Após o término do enxerto dural, foi passado um fio através do enxerto dural, à altura da cisterna criada, e fixado sobre a aponeurose cervical, com a finalidade de deslocar a plástica em direção caudal, evitando, desta forma, sua aderência ao cerebelo.PALAVRAS-CHAVE: impressão basilar, malformação de Chiari, siringomielia, tonsilectomia, enxerto da dura-máter.

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“…These findings are also referred to in the literature by several other authors 2,7,10,11,18,22,23,[27][28][29][30] .…”

Section: Discussionsupporting

confidence: 83%

“…Many others authors 3,8,18, 27 also used this position, although others prefered the prone position placement 2,10,[28][29][30][31][32] .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Silva¹,

Holanda

2003

Arq. Neuro-Psiquiatr.

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“…Significant syrinx improvement was identified in 43 of 44 patients (97.7%) approximately 6 years after decompression. This was relatively higher than that reported by Munshi and colleagues and Depreitere and colleagues [16,24]. This is consistent with the fact that pediatric patients experience less permanent neurologic injury and higher improvement rates after PFD, owing to their enhanced repair capability and short clinical history [5,25,26].…”

Section: Discussionsupporting

confidence: 84%

Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I

Zhu

Jiang

et al. 2011

Eur Spine J

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Introduction Description of syrinx resolution after posterior fossa decompression (PFD) in patients with scoliosis secondary to Chiari malformation type I (CMI) and syringomyelia (SM) has been rarely reported in the literature. This study was performed to investigate the outcome of PFD in patients with scoliosis secondary to CMI and to identify potential predictive factors for better outcome after PFD. Material and methods Patients with scoliosis secondary to CMI and SM, who had undergone PFD during the period 2000 through 2009, were recruited. Inclusion criteria were (1) age B 18 years, (2) diagnosis of SM associated with CMI, (3) scoliosis as the first complaint, (4) having undergone preoperative and follow-up magnetic resonance imaging (MRI). Patients with acquired CMI anomalies or who had received syringosubarachnoid shunting were excluded. The maximal S/C ratio and syrinx length were measured to evaluate syrinx resolution after PFD. A 20% decrease in S/C ratio or length at the latest follow-up was defined as a significant radiographic improvement and complete resolution was used to describe the syrinx disappearing after PFD.Results 44 patients were recruited. Follow-up MRI was conducted for all 44 patients at 6 ± 3 months postoperatively, for 37 patients at 2 years ± 3 months, for 26 patients at 4 years ± 3 months, and for 15 patients at 6 years ± 3 months. 97.7% (43 of 44) of patients showed significant radiographic improvement by MRI. The distance of tonsillar descent (mm) was correlated significantly with the surgical outcome (r = 0.116, P = 0.013). Significant improvement was observed within 6 months postoperatively, with continued slow improvement after that. ConclusionSyringes showed significant improvement after PFD in most patients with scoliosis secondary to CMI. Resolution generally occurred within 6 months follow-up and continued at a slow rate for several years. In addition, the severity of tonsillar descent is a potential predictor for better improvement after standard PFD.

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“…13, 14 Oldfield et al proposed that CSF enters the spinal cord directly via the perivascular spaces, or so-called Virchow-Robin spaces, by means of arterial pulsations. 13 This is consistent with studies that show movement of water-soluble contrast media from the subarachnoid space to the cavity.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of duraplasty and non duraplasty in Chiari 1 malformation with syringomyleia our institute experience

et al. 2017

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Background: The prevalence of chiari malformation, defined as tonsillar herniations of 3 to 5 mm or greater, is estimated to be in the range of one per 1000 to one per 5000 individuals. The objective was to study the clinical presentation and outcome of ACM syrinx after foramen magnum decompression, c1 posterior arch removal duraplasty and without duraplasty.Methods: The study included 75 cases admitted with ACM with syrinx in neurosurgery ward in King George hospital, Visakhapatnam, Andhra Pradesh, India, during a period of five years.Results: Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns and also correlated with reduction in size of the syrinx cavities. Postoperatively all the patients had decreased neck pain and two third of the patients had improvement in nystagmus, headache and dissociative anaesthesia in few cases.Conclusions: In the available literature, the treatment options offered for ACM syrinx are foramen magnum decompression and c1posterior arch removal, release of compression bands, which were followed in our institute also. We have compared pre-and post of MRI. Clinical improvement has been observed in 2 thirds of patient after a period of 2 year period follow up.

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Effects of Posterior Fossa Decompression with and without Duraplasty on Chiari Malformation-associated Hydromyelia

Cited by 251 publications

References 30 publications

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I

Comparative study of duraplasty and non duraplasty in Chiari 1 malformation with syringomyleia our institute experience

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