The results of surgical treatment of spondylotic radiculomyelopathy with complete cervical laminectomy and posterior foramen magnum decompression

Abstract The clinical presentation, radiological features, and results of surgical treatment were analyzed in 17 cases of hydrosyringomyelia associated with a Chiari malformation, in children and adolescents younger than 20 years of age. The initial symptoms were a skeletal abnormality (71%), such as scoliosis (11 patients) or pes cavus (1 patient), pain or numbness (24%), and motor weakness (6%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (85%), muscle weakness (64%), muscle atrophy (35%), and lower cranial nerve palsy (35%), The characteristic neurological findings were unilateral sensory and motor deficits (65%) with decreased or absent deep tendon reflexes on the same side. The localization of the syrinx on the axial section varied according to the level, even in the same patient. In 11 patients with unilateral sensory disturbances or unilateral sensory and motor deficits, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance at the cervical or thoracic level. On the other hand, in 6 patients with bilateral sensory and motor deficits, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side. A syringosubarachnoid shunt was placed in 16 patients, foramen magnum decompression without closure of the obex was performed in 1 patient, ventriculoperitoneal shunt in 1 patient, terminal syringostomy in 1 patient, and foramen magnum decompression with terminal syringostomy in 1 patient. In 15 of 17 patients (88%), the neurological symptoms improved after an average follow-up of 4 years and 1 month. We think that as a surgical treatment, placement of a syringosubarachnoid shunt is effective.

Download Full-text

Different surgical treatment techniques used by neurosurgeons and orthopedists for syringomyelia caused by Chiari I malformation in Japan

Journal of Neurosurgery Spine ◽

10.3171/2013.3.spine12837 ◽

2013 ◽

Vol 18 (6) ◽

pp. 588-592 ◽

Cited By ~ 14

Author(s):

Ken Sakushima ◽

Kazutoshi Hida ◽

Ichiro Yabe ◽

Satoshi Tsuboi ◽

Ritei Uehara ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Techniques ◽

Foramen Magnum ◽

Chiari I Malformation ◽

Size Reduction ◽

Sensory Disturbance ◽

Cavity Size ◽

Foramen Magnum Decompression ◽

Chiari I ◽

Dural Patch

Object Syringomyelia is a rare disease commonly caused by Chiari I malformation. Surgery by neurosurgeons and orthopedists is a critical treatment for symptomatic patients, and surgical techniques are associated with improved symptoms for these patients. The aim of this study was to determine the different surgical techniques used by neurosurgeons and orthopedists in Japan to treat syringomyelia caused by Chiari I malformation. Methods Patients who had undergone a surgical treatment were identified from a 2-stage postal survey conducted in late 2009. The authors compared the type of surgery performed and its association with cavity size reduction, on the basis of whether patients were receiving care in a neurosurgery or orthopedics department. Results A total of 232 patients with syringomyelia caused by Chiari I malformation were included in this study. Two-thirds of patients were treated in a neurosurgery department and the other third in an orthopedics department. Neurosurgeons preferred foramen magnum decompression (FMD) with dural patch grafting, and orthopedists preferred FMD with dural dissection. Foramen magnum decompression with dural patch grafting was associated with better outcomes than was dural dissection with regard to the following: motor impairment (66% vs 39%, p < 0.05), sensory disturbance (60% vs 43%, p = 0.051), pain (67% vs 47%, p < 0.05), and cavity size (74% vs 58%, p < 0.05). Improved motor function was associated more with cavity size reduction than with sensory disturbance and pain. Conclusions Surgical procedures and outcomes differed, depending on whether the patient's care was managed in a neurosurgery or orthopedics department. Outcomes were better after FMD with dural patch grafting.

Download Full-text

Surgical Treatment of Syringomyelia with Chiari Malformation -Effect of Foramen Magnum Decompression-

Spinal Surgery ◽

10.2531/spinalsurg.5.43 ◽

1991 ◽

Vol 5 (0) ◽

pp. 43-49 ◽

Cited By ~ 10

Author(s):

Izumi Koyanagi ◽

Yoshinobu Iwasaki ◽

Toyohiko Isu ◽

Minoru Akino ◽

Hiroshi Abe ◽

...

Keyword(s):

Surgical Treatment ◽

Chiari Malformation ◽

Foramen Magnum ◽

Foramen Magnum Decompression

Download Full-text

Surgical Treatment of Syringomyelia. Advocation of ” Foramen Magnum Decompression with Lateral Extension”

Spinal Surgery ◽

10.2531/spinalsurg.4.53 ◽

1990 ◽

Vol 4 (0) ◽

pp. 53-60 ◽

Cited By ~ 1

Author(s):

Akira Yamaura ◽

Sadao Arai ◽

Yoshinori Otsuka ◽

Hiroshi Kitahara ◽

Takashi Itabashi ◽

...

Keyword(s):

Surgical Treatment ◽

Foramen Magnum ◽

Foramen Magnum Decompression ◽

Lateral Extension

Download Full-text

Surgical Treatment of Syringomyelia associated with Chiari Type I Malformation : Foramen Magnum Decompression vs Syrinx-subarachnoid Shunt(Chiari malformation, Syringomyelia)

Japanese Journal of Neurosurgery ◽

10.7887/jcns.7.378 ◽

1998 ◽

Vol 7 (6) ◽

pp. 378-380

Author(s):

Toshiaki ABE

Keyword(s):

Surgical Treatment ◽

Chiari Malformation ◽

Foramen Magnum ◽

Type I ◽

Foramen Magnum Decompression ◽

Chiari Type ◽

Chiari Type I Malformation ◽

Chiari Type I

Download Full-text

Prognostic significance of C1–C2 facet malalignment after surgical decompression in adult Chiari malformation type I: a pilot study based on the Chicago Chiari Outcome Scale

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20544 ◽

2020 ◽

pp. 1-7

Author(s):

Michael Lumintang Loe ◽

Tito Vivas-Buitrago ◽

Ricardo A. Domingo ◽

Johan Heemskerk ◽

Shashwat Tripathi ◽

...

Keyword(s):

Pilot Study ◽

Chiari Malformation ◽

Prognostic Significance ◽

Foramen Magnum ◽

Bivariate Analysis ◽

Type I ◽

Foramen Magnum Decompression ◽

Swallowing Function ◽

Chiari Malformation Type I

OBJECTIVEThe authors assessed the prognostic significance of various clinical and radiographic characteristics, including C1–C2 facet malalignment, in terms of surgical outcomes after foramen magnum decompression of adult Chiari malformation type I.METHODSThe electronic medical records of 273 symptomatic patients with Chiari malformation type I who were treated with foramen magnum decompression, C1 laminectomy, and duraplasty at Mayo Clinic were retrospectively reviewed. Preoperative and postoperative Neurological Scoring System scores were compared using the Friedman test. Bivariate analysis was conducted to identify the preoperative variables that correlated with the patient Chicago Chiari Outcome Scale (CCOS) scores. Multiple linear regression analysis was subsequently performed using the variables with p < 0.05 on the bivariate analysis to check for independent associations with the outcome measures. Statistical software SPSS version 25.0 was used for the data analysis. Significance was defined as p < 0.05 for all analyses.RESULTSFifty-two adult patients with preoperative clinical and radiological data and a minimum follow-up of 12 months were included. Motor deficits, syrinx, and C1–C2 facet malalignment were found to have significant negative associations with the CCOS score at the 1- to 3-month follow-up (p < 0.05), while at the 9- to 12-month follow-up only swallowing function and C1–C2 facet malalignment were significantly associated with the CCOS score (p < 0.05). Multivariate analysis showed that syrinx presence and C1–C2 facet malalignment were independently associated with the CCOS score at the 1- to 3-month follow-up. Swallowing function and C1–C2 facet malalignment were found to be independently associated with the CCOS score at the 9- to 12-month follow-up.CONCLUSIONSThe observed results in this pilot study suggest a significant negative correlation between C1–C2 facet malalignment and clinical outcomes evaluated by the CCOS score at 1–3 months and 9–12 months postoperatively. Prospective studies are needed to further validate the prognostic value of C1–C2 facet malalignment and the potential role of atlantoaxial fixation as part of the treatment.

Download Full-text