Use of Minimally Invasive Tubular Retractors for Foramen Magnum Decompression of Chiari Malformation: A Technical Note and Case Series

Zagzoog, Nirmeen; Reddy, Kesava

doi:10.1016/j.wneu.2019.04.094

Cited by 18 publications

(11 citation statements)

References 12 publications

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“…Certain authors support a minimally invasive surgical (MIS) decompression of the foramen magnum, in which an MIS tube is inserted after performing a midline incision no larger than 3 cm. [67][68][69] After performing a midline incision of 2 or 3 cm centered over the atlantooccipital junction, an MIS tube or a Gelpi self-retaining retractor is inserted. The MIS tube limits the extent of the subperiosteal dissection, bone resection, dural peeling or delamination and, if required, durotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, dural peeling led to no postoperative incidents, as compared with duraplasty (4 patients, 40%), but no predictive factors of clinical amelioration following dural peeling were discovered. Certain authors support a minimally invasive surgical (MIS) decompression of the foramen magnum, in which an MIS tube is inserted after performing a midline incision no larger than 3 cm 67‐69 . After performing a midline incision of 2 or 3 cm centered over the atlantooccipital junction, an MIS tube or a Gelpi self‐retaining retractor is inserted.…”

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%

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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“…Dealing the cerebellar tonsils also vary like not touching them [27,31], separating them by dissection [28,32], shrinking by bipolar coagulation [13,19,23,33,34] or carrying out a subpial resection [8,19,35,36]. Recently, minimal invasive endoscopy assisted decompression at the foramen magnum for CM have also been reported [37,38].…”

Section: Common Surgical Approaches For Chiari Malformationmentioning

confidence: 99%

Role of Cranioplasty in Management of Chiari Malformation

Rahman¹

2020

Neurosurgical Procedures - Innovative Approaches

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Chiari malformations (CM) are a set of enigmatic congenital anomalies, owing to their complex pathology, varied presentations and management dilemma. Because of the daunting nature of this disease, a universal definitive treatment protocol is yet to be established. Diverse surgical procedures are in practice with various philosophies, aiming to resolve different sections of the pathologies of this disorder, either singly or in combination. However, outcomes are quite variable. Though not a well-recognized and commonly practiced paradigm of managing CM, different techniques of cranioplasty for CM has been described by many authors with variable rates of success. Cranioplasty for Chiari has been found to be helpful in different circumstances with the objective to address different predicaments. Initially, it has been exercised as one of the modalities to manage some particular situations, mostly in cases to solve complications following surgery. Now in some centers, different types of methods of cranioplasty are practiced routinely to treat particular set of Chiari patients with specifically set criteria and some have shown success in those certain scenarios. In this chapter, different methods of cranioplasty for Chiari malformation by different authors, strategies behind the techniques and their results are described in brief. "Stealth cranioplasty", a technique devised by our team is also portrayed.

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“…The cerebellar tonsils have been addressed in various ways also like not touching them [108], dissecting to separate them [99,109], shrinking by bipolar coagulation [43,67,100,102,103,110,111], and subpial resection [38,43,67,106,107,110,112]. Recently, minimal invasive endoscopy-assisted decompression at the foramen magnum for CM has also been reported [113,114].…”

Section: Commonly Practiced Surgical Proceduresmentioning

confidence: 99%

“Stealth Cranioplasty” for Adult Chiari Malformation Type 1: A Philosophical Journey of Innovation, Adaptation, and Evolution

Rahman¹

2020

Neurosurgical Procedures - Innovative Approaches

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Chiari malformation (CM) and its management are long debated enigmas for neurosurgeons. Many surgical procedures have been innovated and are in practice for this perplexing and daunting entity to give the patients a satisfactory remedy. But, a unanimously accepted surgical procedure is still lacking to achieve gratifying result. We tried to develop a novel technique, which we call the "stealth cranioplasty (SCP)," to help the adult Chiari malformation type 1 (CM1) patients. In this chapter, the philosophy behind developing the technique of "stealth cranioplasty" by reconstruction of posterior fossa (PF) by cranioplasty with pre-shaped titanium mesh is described. Different stages, difficulties, and modifications of the journey toward the present day status are also elaborated graphically.

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Use of Minimally Invasive Tubular Retractors for Foramen Magnum Decompression of Chiari Malformation: A Technical Note and Case Series

Cited by 18 publications

References 12 publications

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

Interlayer dural split technique for Chiari I malformation treatment in adult—Technical note

Role of Cranioplasty in Management of Chiari Malformation

“Stealth Cranioplasty” for Adult Chiari Malformation Type 1: A Philosophical Journey of Innovation, Adaptation, and Evolution

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