CSF-space volumetric change following posterior fossa decompression in paediatric Chiari type-I malformation: a correlation with outcome

There are various treatment approaches for treating Chiari type I malformation with syringomyelia. Despite various choices, consensus for one particular approach is lacking. The objective of this study is to find out the clinical and radiological outcome of standard posterior fossa decompression incorporating removal of C1 arch with lax duroplasty in such cases. A retrospective study based on data acquired from a single tertiary center were analyzed. All cases who underwent posterior fossa decompression incorporating removal of C1 arch with lax duroplasty over a period of five years were included and their clinical and radiological progress were recorded during OPD follow up at 6 months. Out of 21 cases, occipital headache with nape of neck pain was the predominant complaint accounting to 71% followed by sensory symptoms and motor weakness, 61% and 33% respectively. Pain resolved in 93%, weakness in 71% and sensory symptoms in 69% of the cases. Only one patient developed hydrocephalus requiring shunting. Radiological improvement of syringomyelia were documented in 76.1% of the patients. There was no mortality. Posterior fossa decompression incorporating removal of C1 arch and lax duroplasty is a safe approach with good outcome in patients with Chiari I malformation with syringomyelia.

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A retrospective study on outcomes following posterior fossa decompression with dural splitting surgery in patients with Chiari type I malformation

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.106035 ◽

2020 ◽

Vol 196 ◽

pp. 106035

Author(s):

Sajan Pandey ◽

Lei Li ◽

Rong Hao Wan ◽

Liang Gao ◽

Wei Xu ◽

...

Keyword(s):

Retrospective Study ◽

Posterior Fossa ◽

Posterior Fossa Decompression ◽

Type I ◽

Chiari Type ◽

Chiari Type I Malformation ◽

Chiari Type I

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Comparison of surgical outcomes in patients with Chiari Type I malformation receiving posterior fossa decompression with and without duraplasty

Child s Nervous System ◽

10.1007/s00381-020-04667-7 ◽

2020 ◽

Vol 36 (7) ◽

pp. 1399-1405

Author(s):

Samuel Butensky ◽

Shaun Rodgers ◽

Shanna Baron ◽

Steven Schneider ◽

Mark Mittler

Keyword(s):

Posterior Fossa ◽

Surgical Outcomes ◽

Posterior Fossa Decompression ◽

Type I ◽

Chiari Type ◽

Chiari Type I Malformation ◽

Chiari Type I

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Interscapular pain with Chiari Type I malformation attributed to atypical spinal accessory neuralgia

Surgical Neurology International ◽

10.25259/sni_67_2021 ◽

2021 ◽

Vol 12 ◽

pp. 226

Author(s):

Anoop Kumar Singh ◽

Gayatri Kumari

Keyword(s):

Posterior Fossa ◽

Microvascular Decompression ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Posterior Fossa Decompression ◽

Type I ◽

Chiari Type ◽

Spinal Accessory ◽

Chiari Type I Malformation ◽

Chiari Type I

Background: The spinal accessory nerve (XI) is traditionally considered a motor nerve. However, as some studies have documented the presence of nociceptive fibers in XI, vascular XI neural compression may lead to an atypical neuralgia. Case Description: A 27-year-old male presented with a Chiari Type I malformation contributing to interscapular pain. Following a posterior fossa and microvascular decompression of XI, the patient improved, thus confirming the underlying diagnosis of a XI atypical neuralgia. Conclusion: Unilateral, posterior-interscapular deep pain may be due to an atypical spinal accessory nerve (XI) neuralgia rather than a Chiari Type I malformation or syrinx. Posterior fossa decompression, subpial tonsillar resection, and XI nerve microvascular decompression resolved this patient’s complaints. In the future, CTA or MRA vascular studies along with a balanced steady-state gradient echo MRI sequence would be better to document the presence of XI nerve neurovascular compromise.

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