Surgical treatment of pacient with Chiari I malformation in different age categories
DOI:
https://doi.org/10.6016/ZdravVestn.2635Keywords:
neurosurgery, anomaly, age, craniectomy, analysisAbstract
Background: Our intention was to compare surgical treatment of patients with Chiari I malformation in our hospital to treatment in 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. The patients’ information was gathered and a descriptive statistic was made. We reviewed English-language reports on the surgical treatment of CM-I in PubMed and Ovid, and compared our results with other series reported in literature.
Results: Between January 2010 and May 2016 we operated on 10 patients, of whom 8 were women and 2 were men, aged between 11 and 57 years. The duration of symptoms before the operation was between 1 month and 29 years. Eight patients experienced 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. There were no deaths in this group of patients. 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 the conclusion that our results are comparable with the results of similar studies reported in literature. However, in this respect, it should be pointed 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, outcomes of the same type of surgery vary greatly. Surgical treatment must be individualised for each patient.
Downloads
References
1. Bindal AK, Dunsker SB, Tew JM. Chiari I malformation: classification and management. Neurosurgery. 1995;37(6):1069-74.
DOI: 10.1227/00006123-199512000-00005
PMID: 8584146
2. Alden TD, Ojemann JG, Park TS. Surgical treatment of Chiari I malformation: indications and approaches. Neurosurg Focus. 2001;11(1):E2.
DOI: 10.3171/foc.2001.11.1.3
PMID: 16724812
3. Fernandez AA, Guerrero AI, Martinez MI, Vazquez ME, Fernandez JB, Octavio EC, et al. Malformations of the craniocervical junction (chiari type I and syringomyelia: classification, diagnosis and treatment). BMC Musculoskeletal Disorders. 2009. ;10
DOI: 10.1186/1471-2474-10-S1-S1
PMID: 20018097
4. Albert GW, Menezes AH, Hansen DR, Greenlee JD, Weinstein SL. Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome. J Neurosurg Pediatr. 2010;5(6):554-61.
DOI: 10.3171/2010.3.PEDS09489
PMID: 20515326
5. Bao C, Yang F, Liu L, Wang B, Li D, Gu Y, et al. Surgical treatment of Chiari I malformation complicated with syringomyelia. Exp Ther Med. 2013;5(1):333-7.
DOI: 10.3892/etm.2012.784
PMID: 23251294
6. Sindou M, Chávez-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 Neurochir (Wien). 2002;144(10):1005-19.
PMID: 12382129
7. Zhao JL, Li MH, Wang CL, Meng W. A Systematic Review of Chiari I Malformation: techniques and Outcomes. World Neurosurg. 2016;88:7-14.
DOI: 10.1016/j.wneu.2015.11.087
PMID: 26732952
8. Siasios J, Kapsalaki EZ, Fountas KN. Surgical management of patients with Chiari I malformation. Int J Pediatr. 2012;2012:640127.
DOI: 10.1155/2012/640127
PMID: 22811732
9. Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15(2):161-77.
DOI: 10.3171/2014.10.PEDS14295
PMID: 25479580
10. Chotai S, Medhkour A. Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I. Clin Neurol Neurosurg. 2014;125:182-8.
DOI: 10.1016/j.clineuro.2014.07.027
PMID: 25171392
11. Abla AA, Link T, Fusco D, Wilson DA, Sonntag VK. Comparison of dural grafts in Chiari decompression surgery: review of the literature. J Craniovertebr Junction Spine. 2010;1(1):29-37.
DOI: 10.4103/0974-8237.65479
PMID: 20890412
12. 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. Turk Neurosurg. 2010;20(3):303-13.
PMID: 20669102
13. Chen J, Li Y, Wang T, Gao J, Xu J, Lai R, et al. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in adult patients: A retrospective analysis of 103 patients. Medicine (Baltimore). 2017;96(4):e5945.
DOI: 10.1097/MD.0000000000005945
PMID: 28121938
14. Förander 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. Clin Neurol Neurosurg. 2014;125:58-64.
DOI: 10.1016/j.clineuro.2014.07.019
PMID: 25087160
15. Yilmaz A, Kanat A, Musluman AM, Çolak I, Terzi Y, Kayacı S, et al. When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale? World Neurosurg. 2011;75(2):307-13.
DOI: 10.1016/j.wneu.2010.09.005
PMID: 21492735
16. 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. Childs Nerv Syst. 2014;30(8):1419-24.
DOI: 10.1007/s00381-014-2424-5
PMID: 24777296
17. Batzdorf U, McArthur DL, Bentson JR. Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients. J Neurosurg. 2013;118(2):232-42.
DOI: 10.3171/2012.10.JNS12305
PMID: 23176335
18. Chotai S, Kshettry VR, Lamki T, Ammirati M. Surgical outcomes using wide suboccipital decompression for adult Chiari I malformation with and without syringomyelia. Clin Neurol Neurosurg. 2014;120:129-35.
DOI: 10.1016/j.clineuro.2014.02.016
PMID: 24656777
19. 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(2):308-15.
DOI: 10.1227/01.NEU.0000336768.95044.80
PMID: 19190458
20. Aitken LA, Lindan CE, Sidney S, Gupta N, Barkovich AJ, Sorel M, et al. Chiari type I malformation in a pediatric population. Pediatr Neurol. 2009;40(6):449-54.
DOI: 10.1016/j.pediatrneurol.2009.01.003
PMID: 19433279
Downloads
Published
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) 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 (Slovenian Medical Association) has the right to transfer the rights of 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.
