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Several surgical procedures can be applied for syrinx associated with Chiari type 1 malformation; however, it remains controversial as to which approach is the most effective. Here, we evaluated the indications and limitations of foramen magnum decompression (FMD) with or without dural plasty. Forty patients with Chiari type 1 malformation were surgically treated and followed up for > 12 months. Thirty-two patients (80.0%) underwent FMD with removal of only the outer dura mater layer, while eight patients underwent FMD with dural plasty. We evaluated surgery-related complications and preoperative radiological findings affecting syrinx shrinkage rates. Post-surgery, the mean syrinx shrinkage rates were 0.32 ± 0.44 in the outer layer-removal group and 0.72 ± 0.27 in the dural plasty group (P = 0.012). Surgery-related complications were less frequent, but reoperation was more frequent, in the outer layer-removal group. The extent of tonsillar descent significantly affected syrinx shrinkage in FMD with outer layer removal (P = 0.042). The outcomes of both approaches in patients with tonsillar descent < 10.0 mm were similar. The dura mater in the posterior fossa was thin, necessitating dural plasty with FMD, while the spinal dura was sufficiently thick for removal of the outer layer in the Chiari patients. These histological differences corresponded with the inferior margin of the cerebellar tonsil. Recognizing the appropriate surgical indication for achieving good post-procedural outcomes is necessary for reducing complications and improving outcomes of FMD for Chiari type 1 malformations.
This article was published in the following journal.
Name: Neurosurgical review
Chiari Malformation Type I is associated with anomaly of hindbrain with displacement of the cerebellar tonsils into the upper cervical canal.The dural splitting and duraplasty are common methods which...
The current study aimed to assess the two surgical procedures of posterior fossa decompression (PDF) in treating Chiari malformation type I (CM-1) complicated by syringomyelia (SM), and to evaluate th...
Previous studies have shown that the clivus angle gradient is significantly decreased in Chiari malformation Type I (CMI) patients with associated syrinx as compared to CMI only patients and the healt...
The variety of symptoms and radiological findings in patients with Chiari malformation type I makes both the indication for surgery and the technical modality controversial. We report our 5-year expe...
There is a lack of evidence concerning the myriad of surgical techniques for type 1 Chiari malformation (CM 1). The present study evaluated the impact of arachnoid violation with tonsils thermocoagula...
Since Chiari malformation is a common disease, many patients require surgical operation to relieve pressure from the back portion of the skull. The purpose of this research is to compare t...
The aim of this study is to compare the value of multifrequency tympanometry between patients with surgical indication of treatment for a Chiari type I malformation and healthy volunteers.
Duke University Medical Center is investigating the hereditary basis of Chiari type I malformations with or without syringomyelia (CM1/S). Our research is aimed at learning if CM1/S is ind...
The purpose of this study is to better understand the genetic factors related to the Chiari I malformation. In people with this abnormality, the lower part of the skull is smaller than no...
The purpose of this study is to determine whether a posterior fossa decompression or a posterior fossa decompression with duraplasty results in better patient outcomes with fewer complicat...
Surgical procedures performed using a computer that remotely controls surgical instruments attached to mechanical arms designed to perform the tasks of the surgeon.
A group of congenital malformations involving the brainstem, cerebellum, upper spinal cord, and surrounding bony structures. Type II is the most common, and features compression of the medulla and cerebellar tonsils into the upper cervical spinal canal and an associated MENINGOMYELOCELE. Type I features similar, but less severe malformations and is without an associated meningomyelocele. Type III has the features of type II with an additional herniation of the entire cerebellum through the bony defect involving the foramen magnum, forming an ENCEPHALOCELE. Type IV is a form a cerebellar hypoplasia. Clinical manifestations of types I-III include TORTICOLLIS; opisthotonus; HEADACHE; VERTIGO; VOCAL CORD PARALYSIS; APNEA; NYSTAGMUS, CONGENITAL; swallowing difficulties; and ATAXIA. (From Menkes, Textbook of Child Neurology, 5th ed, p261; Davis, Textbook of Neuropathology, 2nd ed, pp236-46)
Surgical procedures done to prevent or reduce the risk of developing cancer or other disease conditions in persons who may be predisposed to such conditions.
Surgery restricted to the management of minor problems and injuries; surgical procedures of relatively slight extent and not in itself hazardous to life. (Dorland, 28th ed & Stedman, 25th ed)
Surgical techniques in which SUTURES are not applied to surgical wounds.
Surgery is a technology consisting of a physical intervention on tissues. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being exci...