scholarly journals Posterior fossa decompression with tonsillectomy in 104 cases of basilar impression, Chiari malformation and/or syringomyelia

2011 ◽  
Vol 69 (5) ◽  
pp. 817-823 ◽  
Author(s):  
José Alberto Gonçalves da Silva ◽  
Adailton Arcanjo dos Santos Jr ◽  
Luiz Ricardo Santiago Melo ◽  
Antônio Fernandes de Araújo ◽  
Giseuda Pessoa Regueira
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Chiari Malformation ◽  
Craniovertebral Junction ◽  
Posterior Fossa Decompression ◽  
Basilar Impression ◽  
Upward Migration ◽  
Cisterna Magna ◽  
Suboccipital Craniectomy ◽  
Prime Objective

The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM) and/or syringomyelia (SM) is based on the restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction through the creation of a large artificial cisterna magna. A small suboccipital craniectomy has been emphasized to avoid caudal migration of the hindbrain structures into the vertebral canal. Nevertheless, the results showed downward migration of the hindbrain related to that type of craniectomy. The authors present, otherwise, the results of 104 cases of BI, CM and/or SM, whose 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. A significant upward migration of the posterior fossa structures was detected by postoperative magnetic resonance imaging.

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

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.

scholarly journals Suboccipital craniectomy with opening of the fourth ventricle and duraplasty: study of 192 cases of craniovertebral malformations

2013 ◽  
Vol 71 (9A) ◽  
pp. 609-614 ◽  
Author(s):  
Jose Alberto Goncalves da Silva ◽  
Adailton Arcanjo dos Santos Jr. ◽  
Maria do Desterro Leiros da Costa ◽  
Everardo Bandeira de Almeida
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Surgical Techniques ◽  
Craniovertebral Junction ◽  
Csf Dynamics ◽  
Upward Migration ◽  
Suboccipital Craniectomy ◽  
Prime Objective ◽  
Large Opening

The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM), and/or syringomyelia (SM) is based on restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction and creation of a large artificial cisterna magna, avoiding the caudal migration of the hindbrain. It is observed that a large craniectomy might facilitate an upward migration of the posterior fossa structures. There are many surgical techniques to decompress the posterior fossa; however, a gold standard approach remains unclear. The authors present the results of 192 cases of BI, CM, and SM treated between 1975 and 2008 and whose surgical treatment was characterized by a large craniectomy without tonsillectomy with the patient in the sitting position, large opening of the fourth ventricle, and duraplasty.

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

2008 ◽  
Vol 66 (2a) ◽  
pp. 184-188 ◽  
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.

Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis

2008 ◽  
Vol 2 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Susan R. Durham ◽  
Kristina Fjeld-Olenec
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Clinical Improvement ◽  
Posterior Fossa ◽  
Chiari Malformation ◽  
Meta Analysis ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Patient Age

Object Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. Methods The authors searched Medline–Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000–2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years. Results Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08–0.69) and a higher rate of cerebrospinal fluid–related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53–23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95–1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91–2.25) were noted between PFDD and PFD. Conclusions Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid–related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.

scholarly journals Improvement of Hydrocephalus in Patients with Chiari Malformation After Posterior Fossa Decompression

2018 ◽  
Vol 27 (1) ◽  
pp. 71-73
Author(s):  
Lindolfo Carlos Heringer ◽  
Matheus Fernandes De Oliveira ◽  
Ulysses Oliveira De Sousa ◽  
Wanderley Cerqueira De Lima ◽  
Ricardo Vieira Botelho
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Clinical Symptoms ◽  
Foramen Magnum ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Cisterna Magna ◽  
Long Time ◽  
Small Posterior Fossa

Introduction. The association between hydrocephalus and Chiari malformation (CM) has not been described frequently. Ventricular dilation affects 7% to 10% of patients with CM, but the ideal choice of surgical treatment is controversial. Wereport a case of a patient with Chiari malformation and hydrocephalus with improvement in clinical symptoms and ventricular dilatation. Case Description. A 19-year-old male complaining of frontal headache when coughing, laughing and during valsalva maneuvers, associated with dizziness for 2 months. Magnetic resonance (MR) showed hydrocephalus and small posterior fossa with overcrowding of contents, characterizing Chiari malformation type I, with cerebellar tonsils protruding through magnum foramen. Patient underwent surgery with posterior fossa decompression in a semi-sitting position and removal of the arc C1.After 3 months of follow-up, headache disappeared becoming asymptomatic. Control MR showed improvement of hydrocephalus with restoration of the cisterna magna and CSF flow. Discussion. Hydrocephalus has been related to CM for a long time. In our case, we performed treatment with intradural and intra-arachnoidal approach with bilateral tonsillectomy without placing ventricular shunt. The cisterna magna was “recreated”. There was improvement of hydrocephalus with decreased Evans ratio index and symptoms disappearance. Although there is no other studies addressing such matter, in this case, the improvement suggests that the CSF compression at the foramen magnum was the cause of associated hydrocephalus with Chiari malformation. 

scholarly journals A case report on result of posterior fossa decompression on syringomyelia in a case of chiary type I malformation

2018 ◽  
Vol 32 (1) ◽  
pp. 160-163
Author(s):  
Asheesh Kumar Gupta ◽  
Avdhesh Shukla ◽  
Anand Sharma ◽  
S.N. Iyengar
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Craniovertebral Junction ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Csf Dynamics ◽  
Prime Objective ◽  
One Year

Abstract The prime objective in the surgical treatment of Chiari malformation (CM) and/or syringomyelia (SM) is based on the restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction through the creation of a large artificial cisterna magna. In this case a patient came to our hospital with type 1 chiary malformation having large syrinx which underwent posterior fossa decompression by midline sub occipital craniectomy with subpial cerebellar tonsillar resection which after one year of follow up we have found significant resolution of syrinx radiologically.

scholarly journals Basilar impression associated with impacted cisterna magna, spastic paraparesis and distress of balance: case report

2006 ◽  
Vol 64 (3a) ◽  
pp. 668-671 ◽  
Author(s):  
José Alberto Gonçalves da Silva ◽  
Maurus Marques de Almeida Holanda ◽  
Maria do Desterro Leiros ◽  
Luiz Ricardo Santiago Melo ◽  
Antônio Fernandes de Araújo ◽  
...  
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Spastic Paraparesis ◽  
Lower Limbs ◽  
Posterior Fossa Decompression ◽  
Basilar Impression ◽  
Cisterna Magna ◽  
Balance Case ◽  
Nuchal Rigidity ◽  
Cerebellar Tonsils

We report on a 48 years-old man with basilar impression without syringohydromyelia, in which the cisterna magna was impacted by the cerebellar tonsils. Six months after posterior fossa decompression there was the disappearance of nuchal rigidity, vertigo, spastic paraparesis and improvement of balance. Nevertheless hyperreflexia and diminished pallesthesia of the lower limbs persisted.

Sign in / Sign up

Export Citation Format

Share Document