scholarly journals Interlayer Dural Split Technique for Chiari I Malformation Treatment in Adult -- Technical Note

2021 ◽  
Author(s):  
Ioan Alexandru Florian ◽  
Mihaela Maria Pop ◽  
Teodora Larisa Timis ◽  
Ioan Stefan Florian
Keyword(s):  
Chiari Malformation ◽  
Chiari I Malformation ◽  
Sensory Loss ◽  
Posterior Arch ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Control Series ◽  
Suboccipital Craniectomy ◽  
Chiari I ◽  
Split Technique

Objective: To present an alternative surgical technique in treating cases of Chiari I Malformation with mild-to-moderate syringomyelia after decompressive suboccipital craniectomy: incising only the outer layer of the dura mater, then dissecting it from the inner layer without opening the latter. Methods and Results: We utilized this technique in a short series of three cases who were admitted in our department for mild symptoms such as intermittent headache and dissociated sensory loss in the upper limbs, caused by a Chiari Malformation Type I. The patients were placed in the sitting position. We performed a reduced median suboccipital craniectomy and resection of the posterior arch of C1 adapted to the level of tonsil descent, from a limited superior half to a complete resection. Afterwards, we incised the outer dural layer, while sparing the inner one. Using a fine dissector, we then split apart the outer and inner layers to the margin of the craniectomy. Through the transparency of the inner layer and the arachnoid, the cerebellum and the medulla were visible and pulsating. An autologous fascia duraplasty was then performed. The postoperative course was favorable in all cases, patients being discharged without any deficits and with complete symptom resolution. Conclusions: Interlayer dural split technique can be used effectively in treating symptomatic cases of type I Chiari malformation in adults, with mild-to-moderate syringomyelia. It is less invasive than opening the dura and possibly more effective than decompressive craniectomy and C1 laminectomy alone. This technique must be validated in a larger case-control series.

Worsening or development of syringomyelia following Chiari I decompression

2013 ◽  
Vol 12 (4) ◽  
pp. 351-356 ◽  
Author(s):  
Robert P. Naftel ◽  
R. Shane Tubbs ◽  
Joshua Y. Menendez ◽  
John C. Wellons ◽  
Ian F. Pollack ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Posterior Arch ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Persistent Symptoms ◽  
Chiari I ◽  
Age Range

Object The effects of posterior fossa decompression on Chiari malformation Type I–induced syringomyelia have been well described. However, treatment of worsening syringomyelia after Chiari decompression remains enigmatic. This paper defines patient and clinical characteristics as well as treatment and postoperative radiological and clinical outcomes in patients experiencing this complication. Methods The authors performed a retrospective review of patients at the Children's Hospital of Pittsburgh and Children's of Alabama who developed worsening syringomyelia after Chiari decompression was performed. Results Fourteen children (age range 8 months to 15 years), 7 of whom had preoperative syringomyelia, underwent posterior fossa decompression. Aseptic meningitis (n = 3) and bacterial meningitis (n = 2) complicated 5 cases (4 of these patients were originally treated at outside hospitals). Worsening syringomyelia presented a median of 1.4 years (range 0.2–10.3 years) after the primary decompression. Ten children presented with new, recurrent, or persistent symptoms, and 4 were asymptomatic. Secondary Chiari decompression was performed in 11 of the 14 children. The other 3 children were advised to undergo secondary decompression. A structural cause for each failed primary Chiari decompression (for example, extensive scarring, suture in the obex, arachnoid web, residual posterior arch of C-1, and no duraplasty) was identified at the secondary operation. After secondary decompression, 8 patients' symptoms completely resolved, 1 patient's condition stabilized, and 2 patients remained asymptomatic. Radiologically, 10 of the 11 children had a decrease in the size of their syringes, and 1 child experienced no change (but improved clinically). The median follow-up from initial Chiari decompression was 3.1 years (range 0.8–14.1 years) and from secondary decompression, 1.3 years (range 0.3–4.5 years). No patient underwent syringopleural shunting or other nonposterior fossa treatment for syringomyelia. Conclusions Based on the authors' experience, children with worsening syringomyelia after decompression for Chiari malformation Type I generally have a surgically remediable structural etiology, and secondary exploration and decompression should be considered.

scholarly journals Chiari Malformation- Report of 3 Cases

2010 ◽  
Vol 23 (1) ◽  
pp. 84-86
Author(s):  
Md Zahed Hossain ◽  
Md Kafil Uddin
Keyword(s):  
Chiari Malformation ◽  
Craniovertebral Junction ◽  
Sensory Loss ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Suboccipital Craniectomy ◽  
Classical Picture

3 cases of chiari malformation type-I were presented with classical picture of spasticity, quadriparesis and dissociated sensory loss and were operated ( Craniovertebral junction decompression by midline suboccipital craniectomy with removal of C1 arch and duroplasty). All the 3 patients were improved. Among them one patient recovered with some morbidity for postoperative other diseases. TAJ 2010; 23(1): 84-86

scholarly journals Spontaneous syrinx resolution in patient with Chiari I malformation: illustrative case

2021 ◽  
Vol 1 (26) ◽  
Author(s):  
Elizabeth Gallo ◽  
Gazanfar Rahmathulla ◽  
Dinesh Rao ◽  
Kourosh Tavanaiepour ◽  
Daryoush Tavanaiepour
Keyword(s):  
Chiari Malformation ◽  
Surgical Intervention ◽  
Chiari I Malformation ◽  
Spontaneous Resolution ◽  
Illustrative Case ◽  
Type I ◽  
Conservative Approach ◽  
Chiari Malformation Type I ◽  
Hindbrain Herniation ◽  
Chiari I

BACKGROUIND Chiari malformations include a spectrum of congenital hindbrain herniation syndromes. In patients with the most common subtype, Chiari malformation Type I, 50% to 75% develop a syrinx. The pathogenesis of syringomyelia is not well understood, with multiple theories outlined in the literature. Although the presence of a syrinx in a patient with Chiari malformation is generally accepted as an indication for surgical intervention, there are documented cases of spontaneous resolution that support a more conservative approach to management. OBSERVATIONS The authors reported a case of spontaneous resolution of a cervical syrinx in an adult with an unchanged Chiari malformation. LESSONS Given the possibility of spontaneous resolution over time, the authors believe a more conservative approach of observation with periodic surveillance, magnetic resonance imaging, and neurological examination should be considered in the management of a patient with a Chiari malformation and associated syringomyelia.

scholarly journals Acquired Chiari I malformation due to lumboperitoneal shunt: A case report and review of literature

2019 ◽  
Vol 10 ◽  
pp. 78
Author(s):  
Aslam Hentati ◽  
Mohamed Badri ◽  
Kamel Bahri ◽  
Ihsen Zammel
Keyword(s):  
Chiari Malformation ◽  
Rare Complication ◽  
Chiari I Malformation ◽  
Clinical Feature ◽  
Type I ◽  
Cerebral Magnetic Resonance Imaging ◽  
Surgical Closure ◽  
Lumboperitoneal Shunt ◽  
Cerebral Mri ◽  
Chiari I

Background: The Type I malformations are supposed to be the result of mesodermal defects that create a congenitally small posterior fossa. However, Chiari malformation could be also “iatrogenic” and then called “acquired” Chiari I malformation. In this study, the authors report the clinical feature of a patient who developed a Chiari I malformation after lumboperitoneal shunt. Case Description: A 35-year-old woman has been suffering from idiopathic intracranial hypertension and rhinorrhea due to an anterior skull base defect. A valveless lumboperitoneal shunt followed by surgical closure of the defect was performed. Six months later, she suffered from major continuous occipital headaches. The neurological examination found a mild cerebellar gait ataxia and cerebellar dysarthria. The cerebral magnetic resonance imaging (MRI) showed a ptosis of the cerebellar tonsils and a disappearance of the cisterna magna; there was no syringomyelia. This herniation was not present before shunt was performed. A replacement of the lumboperitoneal shunt with a pressure-regulated valve chamber was performed. After a 1-year follow-up, the patient reports a marked decrease of the headache as well as the ataxia, and the last cerebral MRI showed resolution of the Chiari I malformation. Conclusions: Symptomatic acquired Chiari malformation with or without syringomyelia as a delayed complication after lumbar shunting is a rare complication, particularly reported in the pediatric population, but could also occur to adult patients. Treating these patients by correcting the shunt’s valve could be enough, but should be monitored, as it may fail to resolve the Chiari malformation even years after treatment.

Advanced Chiari malformation Type I with marked spinal cord atrophy

2005 ◽  
Vol 3 (4) ◽  
pp. 324-327 ◽  
Author(s):  
Yoshiro Ito ◽  
Koji Tsuboi ◽  
Hiroyoshi Akutsu ◽  
Satoshi Ihara ◽  
Akira Matsumura
Keyword(s):  
Spinal Cord ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Type I ◽  
Foramen Magnum Decompression ◽  
Spinal Cord Atrophy ◽  
Chiari Malformation Type I ◽  
Content Type ◽  
Neurological Improvement ◽  
Chiari I

✓ The authors discuss the results obtained in patients who underwent foramen magnum decompression for longstanding advanced Chiari I malformation in which marked spinal cord atrophy was present. This 50-year-old woman presented with progressive quadriparesis and sensory disorders. Magnetic resonance imaging revealed the descent of cerebellar tonsils and medulla associated with remarkable C1—L2 spinal cord atrophy. After a C-1 laminectomy—based foramen magnum decompression, arachnoid dissection and duraplasty were undertaken. These procedures resulted in remarkable neurological improvement, even after 40 years of clinical progression. Spinal cord atrophy may be caused by chronic pressure of entrapped cerebrospinal fluid in the spinal canal.

Nonoperative management of enlarging syringomyelia in clinically stable patients after decompression of Chiari malformation type I

2021 ◽  
Vol 28 (1) ◽  
pp. 28-33
Author(s):  
Nicholas S. Szuflita ◽  
Tiffany N. Phan ◽  
Jason H. Boulter ◽  
Robert F. Keating ◽  
John S. Myseros
Keyword(s):  
Chiari Malformation ◽  
Nonoperative Management ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Suboccipital Craniectomy ◽  
Close Observation ◽  
Lost To Follow Up ◽  
Serial Mri

OBJECTIVE The authors aimed to describe the natural history and optimal management of persistent syringomyelia after suboccipital craniectomy for Chiari malformation type I (CM-I). METHODS A cohort of all patients who presented to a tertiary pediatric hospital with newly diagnosed CM-I between 2009 and 2017 was identified. Patients with persistent or worsened syringomyelia were identified on the basis of a retrospective review of medical records and imaging studies. The management of these patients and their clinical courses were then described. RESULTS A total of 153 children with CM-I and syringomyelia were evaluated between 2009 and 2017. Of these, 115 (68.8%) patients underwent surgical intervention: 40 patients underwent posterior fossa decompression (PFD) alone, 43 underwent PFD with duraplasty, and 32 underwent PFD with duraplasty and fourth ventricle stent placement. Eleven (7.19%) patients had increased syringomyelia on subsequent postoperative imaging. Three of these patients underwent revision surgery because of worsening scoliosis or pain, 2 of whom were lost to follow-up, and 4 were managed nonoperatively with close surveillance and serial MRI evaluations. The syringes decreased in size in 3 patients and resolved completely in 1 patient. CONCLUSIONS Persistent or worsened syringomyelia after CM-I decompression is uncommon. In the absence of symptoms, nonoperative management with close observation is safe for patients with persistent syrinx.

Anterior atlas fracture following suboccipital decompression for Chiari I malformation

2004 ◽  
Vol 1 (1) ◽  
pp. 137-140 ◽  
Author(s):  
Brian A. O'Shaughnessy ◽  
Sean A. Salehi ◽  
Saad Ali ◽  
John C. Liu
Keyword(s):  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Posterior Arch ◽  
Cervical Pain ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Increased Risk ◽  
Downward Displacement ◽  
Chiari I ◽  
Suboccipital Decompression

✓ Chiari I malformation, a congenital disorder involving downward displacement of the cerebellar tonsils through the foramen magnum, is often treated surgically by performing suboccipital craniectomy and C-1 laminectomy. The authors report two cases in which fracture of the anterior atlantal arch occurred during the postoperative period following Chiari I decompression and C-1 laminectomy causing significant neck pain. The findings indicate that interruption of the integrity of the posterior arch of C-1, iatrogenically or otherwise, confers increased risk of anterior arch fracture. A C-1 fracture should therefore be considered in the differential diagnosis of posterior cervical pain in patients who have previously undergone decompression for Chiari I malformation.

scholarly journals Minimally invasive posterior fossa decompression with duraplasty in Chiari malformation type I with and without syringomyelia

2019 ◽  
Vol 10 ◽  
pp. 88 ◽  
Author(s):  
Maria Caffo ◽  
Salvatore M. Cardali ◽  
Gerardo Caruso ◽  
Elena Fazzari ◽  
Rosaria V. Abbritti ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Signs And Symptoms ◽  
Posterior Arch ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Respiratory Impairment ◽  
Lower Cranial Nerve ◽  
Good Outcome

Background: Posterior fossa decompression (PFD), with and without duraplasty, represents a valid treatment in Chiari malformation Type I (CM-I) with and without syringomyelia. Despite a large amount of series reported in literature, several controversies exist regarding the optimal surgical approach yet. In this study, we report our experience in the treatment of CM-I, with and without syringomyelia, highlighting how the application of some technical refinements could lead to a good outcome and a lesser rate of complications. Methods: Twenty-six patients with CM-I, with and without syringomyelia, underwent PFD through a 3 cm × 3 cm craniectomy with the removal of the most median third of the posterior arch of C1 and duraplasty. Signs and symptoms included sensory deficits, motor deficits, neck pain, paresthesias, headache, dizziness, lower cranial nerve deficits, and urinary incontinence. Postoperative magnetic resonance (MR) was performed in all patients. Results: Signs and symptoms improved in 76.9% of cases. Postoperative MR revealed a repositioning of cerebellar tonsils and the restoration of cerebrospinal fluid circulation. In our experience, the rate of complication was 23% (fistula, worsening of symptoms, and respiratory impairment). Conclusion: PFD through a 3 cm × 3 cm craniectomy and the removal of the most median third of posterior arch of C1 with duraplasty represents a feasible and valid surgical alternative to treat patients with CM-I, with and without syringomyelia, achieving a good outcome and a low rate of complications.

Quadriparesis due to the delayed formation of a compressive epidural cerebrospinal fluid collection following suboccipital craniectomy with duraplasty for Chiari malformation Type I

2007 ◽  
Vol 7 (4) ◽  
pp. 450-453 ◽  
Author(s):  
Daniel M. Oberer ◽  
Oran S. Aaronson ◽  
Joseph S. Cheng
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari Malformation ◽  
Fluid Collection ◽  
Spontaneous Intracranial Hypotension ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Suboccipital Craniectomy ◽  
Neurological Insult

✓ The authors describe a previously undocumented complication of suboccipital craniectomy combined with duraplasty for the treatment of Chiari malformation Type I and propose techniques to prevent its occurrence. Although there have been reports of epidural pseudomeningoceles in the setting of spontaneous intracranial hypotension and intracranial hygromas following suboccipital craniectomy with duraplasty, the authors believe this case to be the first instance of quadriparesis caused by the delayed formation of a compressive epidural cerebrospinal fluid collection after suboccipital craniectomy with duraplasty. This complication is significant and must be recognized given the potential severity of neurological insult and the number of these procedures performed yearly in both the pediatric and adult populations.

scholarly journals Cephalometric oropharynx and oral cavity analysis in Chiari malformation Type I: a retrospective case-control study

2017 ◽  
Vol 126 (2) ◽  
pp. 626-633 ◽  
Author(s):  
Aintzane Urbizu ◽  
Alex Ferré ◽  
Maria-Antonia Poca ◽  
Alex Rovira ◽  
Juan Sahuquillo ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Sleep Disorders ◽  
Chiari Malformation ◽  
Case Control ◽  
Posterior Cranial Fossa ◽  
Sensory Loss ◽  
Type I ◽  
Retrospective Case ◽  
Chiari Malformation Type I ◽  
Cranial Fossa

OBJECTIVETraditionally, Chiari malformation Type I has been related to downward herniation of the cerebellar tonsils as a consequence of an underdeveloped posterior cranial fossa. Although the common symptoms of Chiari malformation Type I are occipital headaches, cervical pain, dizziness, paresthesia, and sensory loss, patients often report symptoms related to pharyngeal dysfunction such as choking, regurgitation, dysphagia, aspiration, chronic cough, and sleep disorders. In addition, tracheal intubation is often difficult in these patients. The purpose of this study was to analyze the morphological features of the oropharynx and oral cavity in patients with Chiari malformation Type I to help identify underlying anatomical anomalies leading to these debilitating symptoms.METHODSSeventy-six adult patients with symptomatic Chiari malformation Type I with cerebellar tonsillar descent greater than 5 mm below the foramen magnum and a small posterior cranial fossa and 49 sex-matched controls were selected to perform a retrospective case-control MRI-based morphometric study in a tertiary hospital. Eleven linear and areal parameters of the oropharyngeal cavity on midsagittal T1-weighted MRI were measured and the average values between patients and control cohorts were compared. Correlations between variables showing or approaching statistical significance in these structures and posterior cranial fossa measurements related with the occipital bone were sought.RESULTSSignificant differences were detected for several oropharynx and oral cavity measures in the patient cohort, primarily involving the length and thickness of the soft palate (p = 9.5E-05 and p = 3.0E-03, respectively). A statistically significant (p < 0.01) moderate correlation between some of these variables and posterior cranial fossa parameters was observed.CONCLUSIONSThe existence of structural oropharyngeal and oral cavity anomalies in patients with Chiari malformation Type I was confirmed, which may contribute to the frequent occurrence of respiratory and deglutitory complications and sleep disorders in this syndrome.

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