scholarly journals Results of surgical treatment of patients with basilar invagination associated with type I Chiari malformation

2021 ◽  
Vol 23 (1) ◽  
pp. 83-90
Author(s):  
D. S. Epifanov ◽  
V. B. Lebedev ◽  
A. A. Zuev
Keyword(s):  
Surgical Treatment ◽  
Clinical Picture ◽  
Chiari Malformation ◽  
Neurological Status ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Type I ◽  
Posterior Decompression ◽  
National Medical ◽  
Specific Symptoms

Introduction. Each of the pathologies is rare and can lead to compression of the brainstem and spinal cord, with the development of a “mixed” clinical picture. The tactics of treating such patients differs from one author to another.The objective is to present the author’s experience in treating patients with basilar invagination associated with type I Chiari malformation and to analyze the literature on the methods of surgical treatment of this pathology.Materials and methods. From 2014 to 2019, 3 patients with a basilar invagination and type I Chiari malformation were surgically treated at the N. I. Pirogov National Medical and Surgical Center. Indications for surgical intervention were long-term progressive neurological disorders, lack of effect from conservative therapy. Patients underwent anterior transnasal and posterior decompression of nerve structures followed by stabilization.Results. All patients were evaluated 12 months after surgery. All patients in neurological status showed positive dynamics. According to magnetic resonance imaging of the craniovertebral junction, 2 patients showed positive dynamics: regression of the myelopathy, a decrease in the diameter of the syringomyelic cyst.Conclusion. The criteria for anterior transnasal decompression are the predominance of bulbar disorders and / or paresis in the extremities in the clinical picture; posterior decompression of nerve structures, indicated in the presence of specific symptoms of type I Chiari malformation and / or syringomyelia. Taking into account the results of the latest published studies it can be assumed that stabilization is a necessary option in the treatment of patients with this pathology.

Basilar Invagination

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A39-A47 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Mark F. Abel ◽  
Arnold H. Menezes
Keyword(s):  
Surgical Treatment ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Developmental Anomaly ◽  
Autogenous Bone ◽  
Posterior Decompression ◽  
Neural Axis ◽  
Cervical Traction ◽  
Occipital Condyles

Abstract BACKGROUND Basilar invagination is a developmental anomaly of the craniovertebral junction in which the odontoid abnormally prolapses into the foramen magnum. It is often associated with other osseous anomalies of the craniovertebral junction, including atlanto-occipital assimilation, incomplete ring of C1, and hypoplasia of the basiocciput, occipital condyles, and atlas. Basilar invagination is also associated with neural axis abnormalities, including Chiari malformation, syringomyelia, syringobulbia, and hydrocephalus. Patients frequently present with neurologic symptoms and deficits and warrant surgical treatment to prevent progression. OBJECTIVE To review the management of basilar invagination. METHODS The literature was reviewed in reference to the evaluation and management of basilar invagination, with particular emphasis on the surgical treatment. RESULTS Reducible basilar invagination may be treated with posterior decompression and stabilization. Ventral decompression may be necessary for basilar invagination with neural compression that is not reducible with axial cervical traction. Posterior cervical stabilization is necessary after ventral decompression. Modern rod and screw systems combined with autogenous bone graft enable correction of deformity, immediate stabilization, and high fusion rates. CONCLUSION Basilar invagination is a developmental anomaly and commonly presents with neurologic findings. Treatment is typically surgical and involves anterior decompression followed by posterior stabilization for irreducible invagination and posterior decompression and stabilization for reducible invagination.

scholarly journals Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

2018 ◽  
Vol 28 (3) ◽  
pp. 262-267 ◽  
Author(s):  
Tatsushi Inoue ◽  
Natsuki Hattori ◽  
Tsukasa Ganaha ◽  
Tadashi Kumai ◽  
Shinichiro Tateyama ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Intervention Strategy ◽  
Essential Element ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Type I ◽  
Atlantoaxial Joint ◽  
Chiari Malformation Type I ◽  
Neurological Improvement ◽  
Joint Distraction

Chiari malformation type I (CM-I) is typically treated with foramen magnum decompression. However, a recent study proposed a new technique for patients with CM-I, wherein only short atlantoaxial joint fusion and distraction is applied. Posterior fusion with or without atlantoaxial distraction is a potential option for patients with CM-I associated with basilar invagination or complex anomalous bony craniovertebral junction pathology, since this procedure allows clinicians to avoid using the technically demanding transoral approach in which some or all of the odontoid tip is invisible. Distraction of the atlantoaxial joint reduces ventral cervicomedullary compression, leading to neurological improvement. Here, the authors report the case of a 50-year-old woman with CM-I plus basilar invagination whose condition immediately improved but then gradually deteriorated following atlantoaxial joint distraction and fusion. Therefore, the authors performed endonasal/transoral odontoidectomy, which resulted in prolonged neurological recovery. Short atlantoaxial fusion with distraction is a smart and ideal surgical planning concept that can result in significant neurological improvement. However, this case suggests that anterior odontoidectomy is still an essential element of the intervention strategy for patients with CM-I with complex craniovertebral junction pathology.

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 Diabetic polyneuropathy: features of the clinical picture and electroneuromyographic parameters in the presence of comorbidity

2020 ◽  
pp. 39-49
Author(s):  
V. M. Dubynetska
Keyword(s):  
Clinical Picture ◽  
Type I Diabetes ◽  
Diabetic Polyneuropathy ◽  
Neurological Status ◽  
Control Group ◽  
Type I ◽  
Abductor Hallucis ◽  
Fiber Damage ◽  
Left And Right ◽  
Group B

Knowledges of certain key moments in the clinical course of diabetic polyneuropathy (DP) combined with varied comorbidity will allow the disease to be identified more effectively and treated comprehensively at different stages of onset. The aim of the research: was to investigate and summarize the features of the clinical picture, electroneuromyographic parameters in patients with DP in the presence of comorbidity. Materials and methods. 111 patients aged 19 to 69 years with DP were examined. The patients were divided into two groups: DP due to type I diabetes mellitus (DM) (group A; n = 61) and type II (group B; n = 50). According to the detected comorbidity, the following subgroups were identified: persons with DP as the result of type I, II DM with only one pathology (subgroup 1; n = 53) and the presence of multimorbidity (two or more pathologies) (subgroup 2; n = 21). The control group – 30 healthy persons representative by age and gender, 37 patients with DP without comorbidity. The patients were examined for neurological status, laboratory tests, instrumental examination methods. Results and discussion. In general, among the studied groups, the lowest nerve conduction velocity in the motor fibers was in abductor hallucis, tibialis on the left, extensor digitorum brevis, peroneus on the left and right, in sensory fibers – peroneus superficialis on the left and right, n. suralis on the left and right. Such changes primarily reflect the lesion of the distal extremities, which clinically looks like a distal symmetrical DP. Was dominated axonal and demyelinating type of nerve fiber damage. Conclusions. Comorbidity contributes to the progression of DP and deterioration of its clinical picture, electroneuromyographic rates, even in the presence of a single pathology, low duration of DM and HbA1c level.

scholarly journals Autologous cervical fascia duraplasty in 123 children and adults with Chiari malformation type I: surgical technique and complications

2018 ◽  
Vol 22 (3) ◽  
pp. 297-305 ◽  
Author(s):  
Brian J. Dlouhy ◽  
Arnold H. Menezes
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Aseptic Meningitis ◽  
Chiari Malformation ◽  
Senior Author ◽  
Csf Leak ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Fascia Graft ◽  
Prospective Database

OBJECTTechniques for combined extradural and intradural decompression with expansile duraplasty for Chiari malformation type I (CM-I) have been well described, with various allogenic and autologous materials used for duraplasty. However, the approach and surgical technique used for duraplasty in our treatment of CM-I and developed by the senior author in the 1990s has not been described.METHODSA prospective database was initiated in March 2003 to denote the use of cervical fascia for duraplasty and incorporate an ongoing detailed record of complications during the surgical treatment of children and adults with CM-I with and without syringomyelia. A total of 389 surgeries for CM-I were performed on 379 patients from March 2003 to June 2016. A total of 123 posterior procedures were performed on 123 patients in which both a posterior fossa extradural and intradural decompression with duraplasty (extra-intradural) was performed. In this paper the authors describe the surgical technique for harvesting and using cervical fascia for duraplasty in the surgical treatment of CM-I and analyze and discuss complications from a prospective database spanning 2003–2016.RESULTSThe authors found that cervical fascia can be harvested in patients of all ages (2–61 years old) without difficulty, and it provides a good substitute for dura in creating an expansile duraplasty in patients with CM-I. Cervical fascia is an elastic-like material with a consistency that allows for a strong watertight closure. Harvesting the cervical fascia graft does not require any further extension of the incision superiorly or inferiorly to obtain the graft. Complications were uncommon in this study of 123 children and adults. The risk of any type of complication (aseptic meningitis, CSF leak, pseudomeningocele, infection, development of hydrocephalus, and need for ventriculoperitoneal shunt) for the 78 patients in the pediatric age group was 0%. The risk of complication in the adult group was 6.7% (1 patient with aseptic meningitis and 2 patients with CSF leak).CONCLUSIONSAutologous cervical fascia is easy to obtain in patients of all ages and provides an effective material for duraplasty in the treatment of CM-I. Complications from the combination of both an extradural and intradural decompression with autologous cervical fascia duraplasty are uncommon.

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

2017 ◽  
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

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).

scholarly journals Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis

2020 ◽  
Vol 162 (7) ◽  
pp. 1553-1563 ◽  
Author(s):  
Arthur Wagner ◽  
Lukas Grassner ◽  
Nikolaus Kögl ◽  
Sebastian Hartmann ◽  
Claudius Thomé ◽  
...  
Keyword(s):  
Literature Review ◽  
Critical Analysis ◽  
Chiari Malformation ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Type I ◽  
Chiari Malformation Type I
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