Minimally Invasive Approach to Decompression for Chiari Malformation Type 1

Abstract

Objective: Chiari malformation type 1 (CM1) is a congenital hindbrain abnormality characterized by downward displacement of the cerebellar tonsils through the foramen magnum. The widespread accessibility of advanced technologies and imaging modalities has led to an increase in the popularity of minimally invasive (MIS) techniques in cranial and spinal pathologies. Methods: The study was conducted at a university hospital in Bogotá, Colombia. All data were obtained from the database of the hospital’s Neurosurgery Department. After institutional review board approval, the medical records of patients who underwent MIS posterior fossa decompression for CM1 were retrospectively reviewed.Results: Thirty-six patients underwent posterior fossa decompression through a minimally invasive approach during the study period. Nineteen patients met the inclusion criteria and were included in the data analysis. The patients’ chief complaints were headache (78.9%) and neck pain (57.9%). The average surgical time was 158.2 ± 50.5 minutes, with no significant difference in timing among different specialists. The most common postoperative complications were associated with dura closure, including 6 patients with pseudomeningocele and one patient with cerebrospinal fluid leak.Conclusion: Different surgical techniques have been proposed for posterior fossa decompression of CM1. In the present study, we favor a minimally invasive approach to the craniocervical junction to preserve as much of the normal anatomy as possible and avoid alterations in spinal biomechanics.