Foramen Magnum Decompression with Removal of the Outer Layer of the Dura as Treatment for Syringomyelia Occurring with Chiari I Malformation

Isu, Toyohiko; Sasaki, Hiroshi; Takamura, Hiroyuki; Kobayashi, Nobuaki

doi:10.1097/00006123-199311000-00009

Cited by 99 publications

(81 citation statements)

References 22 publications

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“…10 The association of syringomyelia with CM-I has been reported to range from 30% to 70% 64 and 37% to 75%. 27,79,98,99,110,117 This review also demonstrates the exact association of syringomyelia with CM-I in operative series. Ranges were 20%-100% in the adult series, 12%-100% in the pediatric series, and 32%-100% in the combined series.…”

Section: 153mentioning

confidence: 66%

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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

205

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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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Section: 153mentioning

confidence: 66%

“…4,8,13,14,[16][17][18][19]21,22,29,36,45,48,49,57,62,71,79,82,84,85,95,105,113,[118][119][120][122][123][124][125]127,128,137,149,151 In the pediatric series that reported an association of syringomyelia, of a total of 1678 patients, 673 (40%) harbored a syrinx. [1][2][3]15,24,28,[30][31][32][33]35,41,42,50,51,…”

Section: Incidence Of Syringomyeliamentioning

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

205

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“…The surgical technique for PFD, which consisted of suboccipital craniectomy, C-1 laminectomy and duraplasty, was standardized for all recruited patients, as described by Isu [13]. Patients were placed in the prone position with the head fixed in a horseshoe head holder.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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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“…Recently, FMD without dural opening has been preferred because of the theoretical advantages such as shorter operative time and lower risk of cerebrospinal fluid (CSF) leak and postsurgical complications. 2,6) FMD with duraplasty may be more effective and necessary in some cases, 3,10) but is associated with various complications. 1,7,9,11) CSF leakage after FMD with duraplasty is one of the most common complications.…”

Section: Introductionmentioning

confidence: 99%

Subacute Subdural Hygroma and Presyrinx Formation After Foramen Magnum Decompression With Duraplasty for Chiari Type 1 Malformation -Case Report-

Suzuki

Kitagawa

Takagi

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 15-year-old girl developed a rare case of subdural hygroma after foramen magnum decompression for Chiari type 1 malformation manifesting as rapid symptom deterioration around 10 days after uncomplicated operation with uneventful immediate postoperative course. Progressive enlargement of the subdural hygroma in both supra-and infratentorial spaces was followed by the development of hydrocephalus. Syringomyelia improved shortly after the first operation but then deteriorated with massive presyrinx formation. Reoperation with wide opening of the arachnoid membrane lead to a rapid resolution of the hydrocephalus and the presyrinx. The present case shows that wide opening of the arachnoid membrane is an effective therapeutic option.

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Foramen Magnum Decompression with Removal of the Outer Layer of the Dura as Treatment for Syringomyelia Occurring with Chiari I Malformation

Cited by 99 publications

References 22 publications

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

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

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

Subacute Subdural Hygroma and Presyrinx Formation After Foramen Magnum Decompression With Duraplasty for Chiari Type 1 Malformation -Case Report-

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