Surgical treatment of pacient with Chiari I malformation in different age categories
Abstract
Background: Compare surgical treatment of patients with Chiari I malformation in our hospital to other hospitals in the world and determine the outcome and usability of different surgical techniques.
Methods: We conducted a retrospective analysis of 10 patients who were operated for CM-I at the University Clinical Centre Maribor, Division of Surgery, Department of Neurosurgery, between January 2010 and May 2016. Patients’ information was gathered and a descriptive statistic was made. We reviewed the English literature in PubMed and Ovid on the surgical treatment of CM-I, and our results were compared with those of other series in the literature.
Results: Between January 2010 and May 2016 we operated on 10 patients, 8 were women and 2 men, at an age of 11-57 years. The duration of symptoms before the operation was between 1 month and 29 years. Eight patients had headaches, 4 neck pain, 2 vertigo, and one had a feeling of pins and needles in his arms. The duration of the neurological signs before surgery was between 1 and 29 years. Two patients had spastic tetraparesis, two showed sensory deficits and one had tremor of the hands. Five patients had syringomyelia and 2 had scoliosis. All 10 patients underwent surgery. In this group of patients there were no deaths. Two patients had fluid collection in the subcutaneous tissue, one patient also had fever and haematoma, and two patients had discharge from the wound. Patients were followed for 6 months to 6 years and all showed improvement of clinical symptoms.
Conclusion: We have come to a conclusion that our results are comparable with the results of similar studies reported in the literature. But we have to point out that the number of patients included in our study was relatively small. Obviously, there is no specific entity as to when to decide for a specific type of surgery. Also, there is a great variety in the outcomes of the same type of surgery. Surgical treatment must be individualised for each patient.
Downloads
References
Blindal AK, Dunsker SB, Tew JM. Chiari I malformation: Classification and Management. Neurosurgery.1995;37:1069-1074.
Alden TD, Ojemann JG, Park TS.Surgical treatment of Chiari I malformation: indications and approaches. Neurosurgery Focus.2001;11:1-5.
Fernandez AA, Guerrero AI, Martinez MI, Vazquez MEA, Fernandez JB, Octavio EC, et al. Malformations of the craniocervical junction (chiari type I and syringomyelia: classification, diagnosis and treatment). BioMed Central Ltd.; 2009 (cited 2017 May 31). Available from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-10-S1-S1.
Albert GW, Menezes AH, Hansen DR, Greenlee JDW, Weinstein SL. Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome. Journal of Neurosurgery Pediatrics. 2010;5:554-561.
Bao C, Yang F, Liu L, Wang B, Li D, Gu Y, e tal. Surgical treatment of Chiari I malformation complicated with syringomyelia. Experimental & Therapeutic Medicine. 2013;5:333-337.
Sindou M, Chavez-Machuca J, Hashish H. Cranio-Cervical Decompression for Chiari Type I-Malformation, Adding Extreme Lateral Foramen Magnum Opening and Expansile Duroplasty with Arachnoid Preservation. Technique and Long-Term Functional Results in 44 Consecutive Adult Cases-Comparison with Literature Data. Acta Neurochirurgica. 2002;144:1005-1019.
Zhao JL, Li MH, Wang CL, Meng W. A Systematic Review of Chiari I Malformation: Techniques and Outcomes. World Neurosurgery. 2016;BB:7-14.
Siasios J, Kapsalaki EZ, Fountas KN. Surgical Management of Patients with Chiari I Malformation. International Journal of Pediatrics.2012;1:10.
Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari I malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. Journal of Neurosurgey Pediatrics. 2015;15:161-177.
Chotai S, Medhkour A. Surgical outcomes after posterior fossa decompression with and without furaplasty in Chiari malformation-I. Clinical Neurology and Neurosurgery. 2014;125:182-188.
Abla AA, Link T, Fusco D, Wilson DA, Sonntag VKH. Comparison of dural grafts in Chiari decompression surgery: Review of the literature. Journal of Craniovertebral Junction and Spine. 2010;1:29-37.
Erdogan E, Cansever T, Secer HI, Temiz C, Sirin S, Kabatas S, et al. The evaluation of Surgical Treatment Options in the Chiari Malformation Type I. Turkish Neurosurgery. 2010;3:303-313.
Chen J, Li Y, Wang T, Gao J, Xu J, Ali R, et al. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in adult patients. Medicine. 2016;96:4.
Fӧrander P, Sjåvik K, Solheim O, Riphagen I, Gulati S, Salvesen Ø, et al. The case for duraplasty in adults undergoing posterior fossa decompression for Chiari I malformation: A systematic review and meta-analysis of observational studies. Clinical Neurology and Neurosurgery. 2014;125:58-64.
Yilmaz A, Kanat A, Musluman AM, Çolak I, Terzi Y, Kayaci S, et al. When Is Duraplasty Required in the Surgical Treatment of Chiari Malformation Type I Based on Tonsillar Descending Grading Scale?. World Neurosurgery. 2011;75:307-313.
Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD. Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation. Child's Nervous System. 2014;30:1419-1424.
Batzdorf U, McArthur DL, Bentson JR. Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients. Journal of Neurosurgery. 2013;118:232-242.
Chotai S, Kshettry VR, Lamki T, Ammirati M. Surgical outcomes using wide suboccipital decompression for adult Chiari I malformation with and without syringomyelia. Clinical Neurology and Neurosurgery. 2014;120:129-135.
Aghakhani N, Parker F, David P, Morar S, Lacroix C, Benoudiba F, et al. Long-term Follow-up of Chiari-related Syringomyelia in Adults: Analysis of 157 Surgically Treated Cases. Neurosurgery.2009;64:308-315.
Aitken LA, Lindan CE, Sidney S, Gupta N, Barkovich AJ, Sorel M, et al. Chiari Type I Malformation in a Pediatric Population. Pediatric Neurology. 2009;40:449-54.
Copyright (c) 2019 Slovenian Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
