Surgical results of posterior fossa decompression for patients with Chiari I malformation

Navarro, Ramón; Olavarria, Greg; Seshadri, Roopa; Gonzales-Portillo, Gabriel; McLone, David G.; Tomita, Tadanori

doi:10.1007/s00381-003-0883-1

Cited by 203 publications

(175 citation statements)

References 29 publications

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“…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: 85%

“…This discordance may be related to broad age range, different surgical procedures, or variability in the definition of significant improvement. In general, pediatric patients have a better response to PFD than adults [5], implying that the more pediatric patients recruited for a study, the better the surgical outcome. Different surgical procedures might decompress the cerebellar tonsils to different extents or even exert a direct effect on the syrinx, resulting in different rates of significant syrinx improvement [4,8,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Results showed that syrinx improvement occurred mainly within 6 months and continued at a slow rate within 6 years after posterior fossa decompression [12]. Several factors, such as sex, preoperative size and syrinx length, have been reported as predictors of better surgical outcome after PFD [4,5,20]. Badie et al [27] reported that female patients have a better response to PFD than male patients because female patients have a lower posterior fossa volume.…”

Section: Discussionmentioning

confidence: 99%

“…There is broad consensus on the role of mechanical blockage of cerebrospinal fluid flow at the craniocervical junction in the pathogenesis of SM secondary to CMI [1,2]. Posterior fossa decompression (PFD) is currently preferred by most surgeons as the standard surgical option in the treatment of SM secondary to CMI [3][4][5][6]. This results in decompression of the cerebellar tonsil restores the normal cerebrospinal fluid flow [7].…”

Section: Introductionmentioning

confidence: 99%

“…This results in decompression of the cerebellar tonsil restores the normal cerebrospinal fluid flow [7]. Several studies have shown the effectiveness of PFD for treatment of syrinx in these patients: 50-100% experienced a decrease in size of spinal cavity [5,[8][9][10][11]. Recently, Wetjen et al [12] performed a serial magnetic resonance imaging (MRI) study to establish the time course for syrinx resolution after PFD and found that the syrinx began to resolve within 3.6 months after decompression and continued to decrease for months to years.…”

Section: Introductionmentioning

confidence: 99%

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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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