Additional Assessment of Developed Occipital Sinus Using Intraoperative Indocyanine Green Videoangiography for a Safe Foramen Magnum Decompression—Technical Case Report

2020 ◽  
Vol 19 (5) ◽  
pp. E533-E537
Author(s):  
Koji Omoto ◽  
Yasuhiro Takeshima ◽  
Fumihiko Nishimura ◽  
Ichiro Nakagawa ◽  
Yasushi Motoyama ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Contrast Ratio ◽  
Foramen Magnum ◽  
The Body ◽  
Cranial Bone ◽  
Cerebellar Tonsil ◽  
Cleidocranial Dysplasia ◽  
Foramen Magnum Decompression ◽  
Occipital Sinus ◽  
Venous Circulation

Abstract BACKGROUND AND IMPORTANCE Although foramen magnum decompression (FMD) with expansive duraplasty is a popular procedure for treating chiari malformation (CM), the common Y-shaped dural incision can lead to a life-threatening cerebral venous circulation disturbance in patients with a developed occipital sinus. Here, we describe the effectiveness of intraoperative indocyanine green video angiography (ICG-VA) for a CM type 1 (CM1) patient with a highly developed unilateral occipital sinus. CLINICAL PRESENTATION A 40-yr-old woman presented with sensory disturbance on the left side of the body. Magnetic resonance imaging (MRI) revealed cerebellar tonsil herniation into the foramen magnum with cervical syringomyelia, and computed tomography additionally revealed skull anomalies: fontanel closure insufficiencies, cranial dysraphism, thin cranial bone, and dentition abnormalities. We diagnosed as symptomatic CM1 with syringomyelia associated with cleidocranial dysplasia, which is a dominantly inherited autosomal bone disease. Cerebral angiography revealed a developed right occipital sinus and hypoplasia of the bilateral transverse sinus. We performed FMD, paying special attention to the developed occipital sinus using ICG-VA to ensure a safe duraplasty. The angiography clearly highlighted a right-sided occipital sinus with a high contrast ratio, and no left-sided occipital sinus was visible. After a dural incision in a unilateral curvilinear fashion was safely completed, expansive duraplasty was performed. The sensory disorders experienced by the patient disappeared postoperatively. Postoperative MRI revealed elevation of the cerebellar tonsil and decreasing of the syringomyelia. CONCLUSION Additional assessment using intraoperative ICG-VA provides useful information for a safe FMD, particularly in patients with complicated cerebral venous circulation anomalies.

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

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.

Hydrosyringomyelia Associated with a Chiari I Malformation in Children and Adolescents

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 591-597 ◽  
Author(s):  
Toyohiko Isu ◽  
Yoshinohu Iwasaki ◽  
Minoru Akino ◽  
Hiroshi Abe
Keyword(s):  
Surgical Treatment ◽  
Children And Adolescents ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Motor Deficits ◽  
Foramen Magnum Decompression ◽  
Axial Section ◽  
Lower Cranial Nerve ◽  
Thoracic Level ◽  
Initial Symptoms

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.

scholarly journals Re-evaluation of foramen magnum decompression with dura left open for Chiari I malformation

2017 ◽  
Vol 10 ◽  
pp. 150-154 ◽  
Author(s):  
Tetsuryu Mitsuyama ◽  
Yasuo Aihara ◽  
Takaomi Taira ◽  
Seiichiro Eguchi ◽  
Kentaro Chiba ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Foramen Magnum Decompression ◽  
Chiari I

scholarly journals Splenic Mechanisms of Thrombocytopenia

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. SCI-33-SCI-33
Author(s):  
John W. Semple
Keyword(s):  
Immune Responses ◽  
Reticuloendothelial System ◽  
Lymphoid Organ ◽  
The Body ◽  
White Pulp ◽  
Cellular Mechanisms ◽  
Venous Circulation ◽  
Destructive Processes ◽  
Clinical Conditions ◽  
Red Pulp

The spleen is the largest secondary lymphoid organ in the body and contains up to 25 percent of the body's lymphocyte populations. It is not only responsible for initiating immune responses against a multitude of infectious antigens within its white pulp, it also has the exquisite ability to filter the blood and remove, for example, senescent erythrocytes and platelets. This natural process is carried out within the red pulp of the spleen which is composed monocyte-rich connective tissue cords of Billroth intertwined with sinus cavities lined by parallel-oriented endothelial cells that have interendothelial slits which allow for the mechanical sorting of "old" cells. This occurs because of the inability of the senescent cells to properly migrate through the endothelial fenestrae into the venous circulation allowing them to be identified by cells of the reticuloendothelial system (RES) and quickly destroyed by phagocytosis. This process also allows for the efficient recycling of iron from destroyed erythrocyte hemoglobin molecules. There are a wide variety of clinical conditions that can significantly alter the ability of the RES to destroy blood cells including hereditary blood cell defects, inflammation, cancer and abnormal immune responses. This lecture will focus on the central role that the spleen plays in not only generating immune responses against platelets but also in primarily causing the destruction of both senescent and antibody-opsonized platelets leading to thrombocytopenia. It will discuss the soluble and cellular mechanisms of splenic sequestration, destruction and the ability of the spleen to modulate anti-platelet immunity. Mechanisms involving complement activation, Fc Receptor-mediated phagocytosis, antibody dependent cellular cytotoxicity and platelet self-destruction will be addressed. It will compare the spleen's platelet destructive capabilities with other organs, particularly the liver and will detail how immune responses generated in the white pulp can modulate platelet destructive processes in the red pulp. Disclosures Semple: Amgen: Consultancy, Honoraria, Speakers Bureau; Rigel: Consultancy, Honoraria; UCB: Consultancy, Honoraria.

scholarly journals A Case of Chiari Malformation Type I : Improvement of Syringomyelia and Scoliosis by Foramen Magnum Decompression Alone

1999 ◽  
Vol 8 (11) ◽  
pp. 727-731
Author(s):  
Tetsuya Kubota ◽  
Kenichi Nishiyama ◽  
Akira Tamura ◽  
Kouichi Kawasaki ◽  
Hiroshi Masuda ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Foramen Magnum ◽  
Type I ◽  
Foramen Magnum Decompression ◽  
Chiari Malformation Type I
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