Primary Craniovertebral Anomalies and the Hindbrain Herniation Syndrome (Chiari I): Data Base Analysis

Menezes, Arnold H.

doi:10.1159/000120969

Cited by 186 publications

(93 citation statements)

References 17 publications

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“…The incidence of such anomalies was low compared with other series 43,46 in which these abnormalities appear on average to be present in every fourth patient. The reason for this discrepancy is most likely referral bias.…”

Section: Discussioncontrasting

confidence: 64%

“…There were no clear differences in the incidence of major symptoms between this series and other published reports. 2,5,9,13,16,20,31,34,35,38,43,46,51,54,55,57,59,65,68,70 Not surprisingly, there was a major difference in the time from onset of symptoms to surgery (11 months in this series), compared with pre-MR imaging series. 54,57,59 During the last decade this interval between onset of symptoms and treatment has been similar in other reports.…”

Section: Discussionmentioning

confidence: 67%

“…5,20,24,31,35,38,43,46,54,59,70 The majority of our patients were children and adolescents. The sex distribution showed a female preponderance, which corresponds to some previous reports 31,38,50,58 but not to others in which even distribution was found.…”

Section: Discussionmentioning

confidence: 86%

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Treatment of Chiari type I malformation in patients with and without syringomyelia: a consecutive series of 66 cases

Alzate¹,

Kothbauer²,

Jallo³

et al. 2001

FOC

162

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Object The authors describe the results of performing a standard posterior craniovertebral decompression and placement, if indicated, of a syringosubarachnoid shunt for the treatment of patients with Chiari I malformation with and without syringomyelia. Methods This is a retrospectively analyzed consecutive series of 66 patients (mean patient age 15 years, range 1–53 years). The uniform posterior craniovertebral decompression consisted of a small suboccipital craniectomy, a C-1 laminectomy, microsurgical reduction of the cerebellar tonsils, and dural closure with a synthetic dural graft to increase the cerebrospinal fluid space at the craniocervical junction. The presence of a large syrinx, with significant thinning of the spinal cord tissue and obliteration of the spinal subarachnoid space, particularly when combined with syrinx-related symptoms, was an indication for the placement of a syringosubarachnoid shunt. In 32 patients Chiari I malformation alone was present, and 34 in patients it was present in combination with syringomyelia. Clinical findings included pain, neurological deficits, and spinal deformity. The presence of syringomyelia was significantly associated with the presence of scoliosis (odds ratio 74.4 [95% confidence interval 8.894–622.4]). All patients underwent a posterior craniovertebral decompression procedure. In 22 of the 34 patients with syringomyelia a syringosubarachnoid shunt was also placed. The mean follow-up period was 24 months (range 3–95 months). Excellent outcome was achieved in 54 patients (82%) and good outcome in 12 (18%). In no patient were symptoms unchanged or worse at follow-up examination, including four patients who initially required a second operation for persistent syringomyelia. Pain was more likely to resolve than sensory and motor deficits after decompressive surgery. Radiological examination revealed normalization of tonsillar position in all patients. The syrinx had disappeared in 15 cases, was decreased in size in 17, and remained unchanged in two. Conclusions Posterior craniovertebral decompression and selective placement of a syringosubarachnoid shunt in patients with Chiari I malformation and syringomyelia is an effective and safe treatment. Primary placement of a shunt in the presence of a sufficiently large syrinx appears to be beneficial. The question of if and when to place a shunt, however, requires further, preferably prospective, investigation.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 67%

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Treatment of Chiari type I malformation in patients with and without syringomyelia: a consecutive series of 66 cases

Alzate¹,

Kothbauer²,

Jallo³

et al. 2001

FOC

162

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“…Osseoligamentous CVJ pathology is often associated with Chiari I malformation. 66 Although reduction 25,66 or ventral decompression may treat the osseoligamentous pathology, 60 a dorsal decompression may still be warranted in each case to treat the Chiari malformation or to ensure complete cervicomedullary decompression. The algorithm is a general guide for CVJ pathology and should be used as such when determining the appropriate treatment strategy for each patient.…”

Section: Update Of the Cvj Treatment Algorithmmentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.

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“…We have pointed out before that atlas assimilation and segmentation failures of the upper cervical spine may contribute to ligamentous laxity and proliferation of granulation tissue at the CCJ. 17 Such instability may eventually lead to basilar invagination and irreducibility, and thus a stabilization procedure is indicated.…”

Section: J Neurosurg: Spine / Volume 9 / July 2008mentioning

confidence: 99%

Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia

Fenoy

Menezes

Fenoy

2008

SPI

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Object Patients with hindbrain herniation or the so-called Chiari malformation Type I (CM-I) and/or syringohydromyelia are treated with dorsal decompression alone; however, a small percentage of patients with other associated abnormalities require concomitant dorsal craniocervical junction (CCJ) fusion. The authors surveyed the indications for CCJ fusions in this population. Methods A retrospective review of University of Iowa medical records and radiographs obtained between 1996 and 2005 was performed. Inclusion criteria encompassed patients with diagnoses of CM-I and/or syringohydromyelia requiring dorsal CCJ fusions, and others with CCJ abnormalities who had CM-I and/or syringohydromyelia. Results Two hundred thirty-four patients were identified, all of whom were symptomatic at presentation. Their ages ranged from 2.5 to 86 years; 33% of the patients were < 16 years of age. Patients were categorized as follows, with some being assigned to > 1 category: Group I, congenital or acquired CCJ abnormalities with reducible bone compression (25% of patients); Group II, previous anterior CCJ/upper brainstem decompression (44%); Group III, occipitocervical complex instability with CM-I and/or syringohydromyelia but without CCJ bone abnormalities requiring adjunctive posterior fossa decompression (26%); and Group IV, musculoligamentous instability, either from pathological states or from muscle dehiscence from repeated posterior fossa procedures (14%). Instrumentation was used in 96% of patients, with all 96% receiving semirigid fixation with titanium loop and sublaminar cables; all fusion constructs incorporated autologous bone. At last follow-up evaluation, fusion was radiographically complete in 97%, and symptom improvement was seen in 92%. Conclusions Dorsal CCJ fusions are required in patients with CM-I and/or syringohydromyelia who have concomitant CCJ abnormalities (Groups I and II). A definite group (CM-I and/or syringohydromyelia) without bone abnormality exists (Groups III and IV). This may be due to muscle weakness secondary to a high syrinx.

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Primary Craniovertebral Anomalies and the Hindbrain Herniation Syndrome (Chiari I): Data Base Analysis

Cited by 186 publications

References 17 publications

Treatment of Chiari type I malformation in patients with and without syringomyelia: a consecutive series of 66 cases

Treatment of Chiari type I malformation in patients with and without syringomyelia: a consecutive series of 66 cases

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia

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