Posterior decompression of the craniovertebral junction in children with Chiari malformation: a surgery extent issue

Korshunov, A E; Kushel, Yu V

doi:10.17116/neiro201680413-20

Cited by 7 publications

(5 citation statements)

References 27 publications

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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%

“…Proponents of craniocervical decompression with duraplasty claim that it offers a superior relief of symptoms, an acceptable rate of morbidity, and has a lower rate of reintervention. 35,41,55,56 Even more so, duraplasty leads to a very high rate of resolution of the syringomyelia, although recrudescence of the syrinx has been noted in a small number of cases. 56,57 In the retrospective series of 105 patients treated via duraplasty, De Vlieger et al concluded that the majority of patients describe an amelioration or stabilization of the symptoms, especially if there were no signs of syringomyelia.…”

Section: Discussionmentioning

confidence: 99%

“…There has been a lot of debate regarding the extent of craniectomy, the necessity of dural incision, opening the arachnoid, the removal of the cerebellar tonsils, even the placement of duraplasty and its source, whether autologous or synthetic 35‐39 . Surgery can be performed in either prone, concorde, semi‐sitting, or even sitting position 33,40‐46 . 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.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…However, even close adherence to all main surgical guidelines does not always avoid postoperative complications. The most common complications are pseudomeningocele (12%) and postoperative CSF leak (5%);[ 3 ] however, the occurrence of these conditions in the literature varies significantly,[ 1 , 6 , 7 , 12 , 17 , 19 ] not reaching 1% in some series. [ 27 ] The development of pseudomeningocele (retrooccipital intramuscular and interfascial CSF cysts) may be due to the fact that, despite layer-by-layer suturing of the deep neck muscles, they are not fixed to the occipital bone, as it anatomically occurs before surgery because these complications are observed even in the case of a water-tight duraplasty and application of adhesive compositions.…”

Section: Introductionmentioning

confidence: 99%

A titanium implant for Chiari malformation Type 1 surgery

Мишинов

Samokhin

Panchenko

et al. 2021

Surgical Neurology International

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Background: Concepts of Chiari malformation Type 1 (CM1) surgery in the present time significantly different. The most common complications are pseudomeningocele (12%) and postoperative CSF leak (5%). The development of pseudomeningocele may be associated with inappropriate restoration of bone and muscles relations. Methods: The pilot study involved 11 patients aged 24–64 years with a diagnosis of CM1 who had indications for surgical treatment. Special titanium implant enabling fixation of the occipital and cervical muscles at the projections of their normal attachments was developed, it was placed to occipital bone on the final stages of surgical intervention. Surgical technique promoted tightened wound closure neutralizing formation of “dead space” at the place of occipital craniectomy and between muscle layers. The implant was produced by direct metal laser sintering method for each patient individually. Results: There were no complications during the hospitalization and follow-up period. Postoperative MRI demonstrated adequate formation of the cisterna magna and the absence of pseudomeningocele. During follow-up period there were no signs of pseudomeningocele, CSF leak, surgical scar complications, implant-associated infections, and other complications. Conclusion: In the study group, no pseudomeningocele cases as long as any other complications associated with surgery had been revealed. The efficacy of the proposed surgical technique using the developed implant should be evaluated in clinical trials with larger patient samples. To simplify preoperative planning and manufacturing of the implant for each patient individually, a set of implants with different specified sizes was developed.

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