Basilar impression, Chiari malformation and syringomyelia: a retrospective study of 53 surgically treated patients

The present study shows the results of 53 patients who have been treated surgically for basilar impression (BI), Chiari malformation (CM), and syringomyelia (SM). The patients were divided into two groups. Group I (24 patients) underwent osteodural decompression with large inferior occipital craniectomy, laminectomy from C 1 to C 3, dural opening in Y format, dissection of arachnoid adhesion between the cerebellar tonsils, medulla oblongata and spinal cord, large opening of the fourth ventricle and dural grafting with the use of bovine pericardium. Group II patients (29 patients) underwent osteodural-neural decompression with the same procedures described above plus dissection of the arachnoid adherences of the vessels of the region of the cerebellar tonsils, and tonsillectomy (amputation) in 10 cases, and as for the remainning 19 cases, intrapial aspiration of the cerebellar tonsils was performed. The residual pial sac was sutured to the dura in craniolateral position. After completion of the suture of the dural grafting, a thread was run through the graft at the level of the created cisterna magna and fixed to the cervical aponeurosis so as to move the dural graft on a posterior- caudal direction, avoiding, in this way, its adherence to the cerebellum.

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Retrospective study of patients with Chiari: malformation submitted to surgical treatment

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000200008 ◽

2008 ◽

Vol 66 (2a) ◽

pp. 184-188 ◽

Cited By ~ 6

Author(s):

Mário Augusto Taricco ◽

Luiz Ricardo Santiago Melo

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Posterior Fossa ◽

Chiari Malformation ◽

Posterior Fossa Decompression ◽

Basilar Impression ◽

Iii Ventricle ◽

Complementary Techniques ◽

Cerebellar Tonsils

The Chiari malformation (CM) is characterized by variable herniation of one or both cerebellar tonsils, associated or not with displacement of the hindbrain structures into the vertebral canal. This is a retrospective study of 29 patients with CM submitted to surgical procedure between 1990 and 2003. There were 14 females and 15 males whose ages ranged from 16 to 65 years. There were seven patients with isolated CM, 12 associated with syringomyelia (SM), three associated with basilar impression (BI) and seven associated with SM and BI. The surgery was based on posterior fossa decompression. In seven patients a catheter was introduced from the subarachnoid space into the III ventricle and five were submitted to tonsillectomy. Twenty-one patients improved, one worsened, one remained unchanged, four missed follow up and two died. We conclude that the best results with CM surgery are obtained by an effective posterior fossa decompression. Those CM cases associated with other abnormalities, such as SM and BI, probably need complementary techniques which will be the theme for new prospective studies.

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Impacted cisterna magna without syringomyelia associated or not with basilar impression and/or Chiari malformation

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1625935 ◽

2013 ◽

Vol 32 (01) ◽

pp. 40-47

Author(s):

José Alberto Gonçalves da Silva ◽

Adailton Arcanjo dos Santos Júnior ◽

José Demir Rodrigues

Keyword(s):

Surgical Treatment ◽

Posterior Fossa ◽

Chiari Malformation ◽

Sitting Position ◽

Basilar Impression ◽

Tonsillar Herniation ◽

Upward Migration ◽

Cisterna Magna ◽

Large Opening ◽

Magnetic Resonance Imaging Mri

Abstract Objective: The objective of this paper is to analyze the surgical treatment of impacted cisterna magna without syringomyelia (SM) associated or not with basilar impression (BI) and/or Chiari malformation (CM). Method: The authors present, in this work, the results of five cases with impacted cisterna magna without SM which were associated with BI in four cases, tonsillar herniation in three patients when they were in the sitting position and in the other two cases there was not herniation in the sitting position. Results: The surgical treatment was characterized by a large craniectomy with the patient in the sitting position, tonsillectomy, large opening of the fourth ventricle and duraplasty with creation of a large artificial cisterna magna. An upward migration of the posterior fossa structures was detected by postoperative magnetic resonance imaging (MRI). Conclusion: The surgical treatment of impacted cisterna magna without SM remains unclear, however, a large craniectomy associated with tonsillectomy and creation of a large cisterna magna showed good results and a tendency of upward migration of the posterior fossa structures.

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Surgical Treatment of C2 Odontoid Process Intussusception in Combination with Type I Chiari Malformation

N N Priorov Journal of Traumatology and Orthopedics ◽

10.32414/0869-8678-2017-1-66-72 ◽

2017 ◽

pp. 66-72 ◽

Cited By ~ 1

Author(s):

A. N. Shkarubo ◽

A. A. Kuleshov ◽

I. V. Chernov ◽

V. A. Shakhnovich ◽

E. V. Mitrofanova ◽

...

Keyword(s):

Spinal Cord ◽

Chiari Malformation ◽

Odontoid Process ◽

Type I ◽

Basilar Impression ◽

Posterior Decompression ◽

Developmental Abnormalities ◽

Brainstem Compression ◽

Upper Cervical ◽

One Step

Type I Chiari malformation is often accompanied by congenital developmental abnormalities such as platybasia, basilar impression and C2 odontoid process retroflexion that may cause anterior compression of brainstem structures and upper cervical segments of spinal cord. Formerly the conventional method was posterior decompression even in presence of anterior brainstem compression. This article presents on a kinetic example the tactics of one-step treatment of patients with type I Chiari malformation accompanied by basilar impression and C2 odontoid process retroflexion via transoral approach only that was used for both decompression and C1-C2 segment anterior stabilization. Surgical intervention enabled to achieve the decompression of brainstem structures and upper cervical segments of spinal cord, normalization liquor dynamics and subsequent redislocation of cerebellar tonsils to normal position (above the Chamberlain line).

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Early descriptions of the Arnold-Chiari malformation

Journal of Neurosurgery ◽

10.3171/jns.1972.37.5.0543 ◽

1972 ◽

Vol 37 (5) ◽

pp. 543-547 ◽

Cited By ~ 44

Author(s):

Peter W. Carmel ◽

William R. Markesbery

Keyword(s):

Brain Stem ◽

Chiari Malformation ◽

Fourth Ventricle ◽

Cervical Canal ◽

Content Type ◽

Anatomical Features ◽

John Cleland ◽

Arnold Chiari Malformation ◽

The Brain ◽

Cerebellar Tonsils

✓ John Cleland described an unusual congenital anomaly of the brain stem in 1883 in which the medulla was elongated, the fourth ventricle extended into the cervical canal, and the inferior vermis distorted caudally. In 1891 Chiari described two types of brain stem malformation; in one the cerebellar tonsils extended into the cervical canal without medullary deformation, while in the other there was caudal extension of the brain stem and cerebellum and prolongation of the inferior vermis into the cervical canal. The second type was termed the “Arnold-Chiari” malformation by other authors in 1907, and corresponds to the condition described earlier by Cleland. The anatomical features and differences between the types of malformation are tabulated.

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Chiari malformations in adults: their surgical and nursing management

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2019.15.3.130 ◽

2019 ◽

Vol 15 (3) ◽

pp. 130-136

Author(s):

Emily Humphrey

Keyword(s):

Spinal Cord ◽

Fourth Ventricle ◽

Nursing Management ◽

Lower Section ◽

Brain And Spinal Cord ◽

The Brain ◽

Cerebellar Tonsils ◽

Chiari Malformations

There are two categories of Chiari malformations that occur in adults: type 1 and type 2. Type 1 Chiari malformations are conditions where the bottommost parts of the back of the brain (called the cerebellar tonsils) descend below the skull and enter the spinal canal—the space around the spinal cord. In type 2 Chiari malformations, more of the brain descends below the skull. This means that, as well as the cerebellar tonsils, the lower section of the brainstem (the medulla) and the brain's lowermost fluid-filled cavity, the fourth ventricle, also descend. The descending structures cause pressure and disrupt the normal flow of fluid that circulates in the brain and spinal cord, known as cerebrospinal fluid (CSF). This article further explains the Chiari malformations, presents theories of how they are caused and describes their symptoms and complications. It also discusses Chiari malformations, theories of causation, symptoms, complications, treatment and nursing management considerations.

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Surgical Treatment of C2 Odontoid Process Intussusception in Combination with Type I Chiari Malformation

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201724166-72 ◽

2017 ◽

Vol 24 (1) ◽

pp. 66-72

Author(s):

A. N Shkarubo ◽

A. A Kuleshov ◽

I. V Chernov ◽

V. A Shakhnovich ◽

E. V Mitrofanova ◽

...

Keyword(s):

Spinal Cord ◽

Chiari Malformation ◽

Odontoid Process ◽

Type I ◽

Basilar Impression ◽

Posterior Decompression ◽

Developmental Abnormalities ◽

Brainstem Compression ◽

Upper Cervical ◽

One Step

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Cerebellum, brainstem and spinal cord adhesions following basilar impression and Chiari malformation surgery

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2010000500026 ◽

2010 ◽

Vol 68 (5) ◽

pp. 807-809

Author(s):

José Alberto Gonçalves da Silva ◽

Luiz Ricardo Santiago Melo ◽

Antônio Fernandes de Araújo ◽

Adailton Arcanjo dos Santos Jr

Keyword(s):

Spinal Cord ◽

Chiari Malformation ◽

Basilar Impression

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Symptomatic Chiari malformations

Journal of Neurosurgery ◽

10.3171/jns.1989.71.2.0159 ◽

1989 ◽

Vol 71 (2) ◽

pp. 159-168 ◽

Cited By ~ 263

Author(s):

Gregg N. Dyste ◽

Arnold H. Menezes ◽

John C. VanGilder

Keyword(s):

Spinal Cord ◽

Posterior Fossa ◽

Fourth Ventricle ◽

Foramen Magnum ◽

Dorsal Column ◽

Term Outcome ◽

Long Term Outcome ◽

Content Type ◽

Dural Graft ◽

Chiari Malformations

✓ The Chiari malformation is a condition characterized by herniation of the posterior fossa contents below the level of the foramen magnum, and is categorized into three types based on the degree of herniation. The authors review their surgical experience between 1975 and 1985 with 50 patients afflicted with symptomatic Chiari malformations. Any patient with associated myelomeningocele, tethered spinal cord, lipoma, or diastematomyelia was excluded from this series. Forty-one patients had Chiari I malformations, seven were classified as having Chiari II, and two as having Chiari III. The presentation of pediatric and adult patients was identical. Treatment was directed at the posterior fossa pathology. Seven patients with accompanying ventral bone compression underwent transoral decompression of the cervicomedullary junction, 42 had posterior decompressive procedures, and six received ventriculoperitoneal shunts. The posterior decompression included opening the outlet foramina of the fourth ventricle, occluding any communication between the spinal cord central canal and the obex, shunting the fourth ventricle, and placing a dural graft. Postoperatively, 20% of the patients are asymptomatic, 66% improved, and 8% stabilized; in 6% the disease has progressed in spite of multiple procedures. Preoperative signs that are predictive of a less favorable outcome include muscle atrophy, symptoms lasting longer than 24 months, ataxia, nystagmus, trigeminal hypesthesia, and dorsal column dysfunction (p < 0.05, chi-square test). A model based on the presence or absence of atrophy, ataxia, and scoliosis at the time of the preoperative examination has been generated that allows prediction of long-term outcome at the 95% confidence level.

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