Outcome of Posterior Fossa Decompression and Duroplasty in Adult Chiari Malformation
DOI:
https://doi.org/10.36570/jduhs.2021.2.1075Keywords:
Chiari malformation decompression, duraplasty, Chicago Outcome Scale, posterior fossaAbstract
OBJECTIVE: Evaluate of Chiari malformations outcome by the method of decompression with duraplasty.
METHOD: This was a prospective descriptive study, duration: 03-03- 2013 to 3-2019 conducted at neuro spinal & cancer care institute, Karachi, the study included 91 patients of CM I, including criteria after diagnosis with the help of MRI cervical spine, a patient having a headache, neck pain, limbs numbness and syringomyelia. Patients excluded from the study are those previously operated previously, history of cervical trauma, operated for a brain tumour.
RESULTS: we had 91 CM patients, 58 (63.7%) were male, and 33 (36.26%) were female patients and the means age for this surgical procedure was 32 years old. Moreover, all of the patients were gone through the Posterior Fossa Decompression, C1 Laminectomy and Duraplasty. For duraplasty, we took autologous cervical fascia, 1patient had C1 assimilation. 12 (13.1%) patients had hydrocephalus; Ventriculoperitoneal (VP) shunt was placed. Headache was in 91 patients with duration resolved in 87 (95.6%) patients, neck pain was in 82 (90.1%) patient resolved in 74 (90.2%) cases, syrinx was in 36 (39.5%) cases improved in 28 (77.8%) cases, cerebellar sign improved in 40 (83.3%) out of 48 (52.7%) patient, limb numbness resolved in 56 (71.7%) out of 78 (85.7%) cases swallowing difficulty was 31( 34.0%)cases and improved in 24 (77.4%) cases and weakness in upper limbs was relieved in 31 (34%) patients.
Downloads
References
Piper RJ, Magdum SA. Chiari 1 malformation and raised intracranial pressure. Childs Nerv Syst 2019; 35:1719-25.
doi: 10.1007/s00381-019-04232-x
Zaffanello M, Sala F, Sacchetto L, Gasperi E, Piacentini G. Evaluation of the central sleep apnea in asymptomatic
children with Chiari 1 malformation: an open question. Childs Nerv Syst 2017; 33:829-32. doi: 10.1007/s00381-017-3399-9
Epstein NE. Definitions and treatments for chiari-1 malformations and its variants: Focused review. Surg Neurol Int 2018; 9:152.doi: 10.4103/sni.sni_208_18
Heffez DS, Golchini R, Ghorai J, Cohen B. Operative findings and surgical outcomes in patients undergoing Chiari 1 malformation decompression: relationship to the extent of tonsillar ectopia. Acta Neurochir (Wien) 2020; 162:1539-47. doi: 10.1007/s00701-019-04172-0
Zuev AA, Pedyash NV, Epifanov DS, Kostenko GV. Results of surgical treatment of syringomyelia associated with Chiari 1 malformation. An analysis of 125 cases. Zh Vopr Neirokhir Im N N Burdenko 2016; 80:27-34. English, Russian. doi: 10.17116/neiro201680127-34
Mozaffari K, Davidson L, Chalif E, Phan TN, Sparks AD, Myseros JS, et al. Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure? Child's Nervous System 2021; 1-8. doi.org/10.1007/s00381-021-05280-y
Zuev AA, Kostenko GV. Lechenie siringomielii u patsientov s anomalieĭ Kiari [Treatment of syringomyelia associated with Chiari 1 malformation]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:102-6. Russian. doi: 10.17116/jnevro201711731102-106
Navarro R, Olavarria G, Seshadri R, Gonzales-Portillo G, McLone DG, Tomita T. Surgical results of posterior fossa decompression for patients with Chiari I malformation. Childs Nerv Syst 2004 ; 20:349-56. doi: 10.1007/s00381-003-0883-1
Sabba MF, Renor BS, Ghizoni E, Tedeschi H, Joaquim AF. Posterior fossa decompression with duraplasty in Chiari surgery: A technical note. Rev Assoc Med Bras 2017; 63:946-9.doi: 10.1590/1806-9282.63.11.946
Abla AA, Link T, Fusco D, Wilson DA, Sonntag VK. Comparison of dural grafts in Chiari decompression surgery: Review of the literature. J Craniovertebr Junction Spine 2010; 1:29-37. doi: 10.4103/0974-8237.65479. PMID: 20890412
Abdulghani YS, Elzain MA, Ali AA, Mohamed HH, Basheer BM. Chiari type-I malformation: Clinical features and surgical outcome assessment using Chicago Chiari Outcome Score (CCOS) among Sudanese patients. Pak J Surg 2019; 35:325-30.
Gallo P, Copley PC, McAllister S, Kaliaperumal C. The impact of neurosurgical technique on the short- and long-term outcomes of adult patients with Chiari I malformation. Clin Neurol Neurosurg 2021; 200:106380. doi: 10.1016/j.clineuro.2020.106380
Kennedy BC, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Anderson RC, et al. Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I. J Neurosurg Pediatr 2015; 16:150-8. doi: 10.3171/2014.12.PEDS14487
Zhao JL, Li MH, Wang CL, Meng W. A Systematic Review of Chiari I Malformation: Techniques and Outcomes.
World Neurosurg 2016; 88:7-14. doi: 10.1016/j.wneu.2015.11.087
Chen J, Li Y, Wang T, Gao J, Xu J, Lai R, et al. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in adult patients: A retrospective analysis of 103 patients. Medicine (Baltimore) 2017; 96:e5945. doi: 10.1097/MD.0000000000005945
Liu B, Wang Y, Liu S, Zhang Y, Lu D, Chen L, et al.Tonsillectomy with modified reconstruction of the cisterna magna with and without craniectomy for the treatment of adult Chiari malformation type I with syringomyelia. Acta Neurochir (Wien) 2020; 162:1585-95. doi: 10.1007/s00701-019-04177-9
Almotairi FS, Tisell M. Acute deterioration of adults with Chiari I malformation associated with extensive syrinx. Br J Neurosurg 2020; 34:13-7. doi: 10.1080/02688697.2019.1684438
Tosi U, Lara-Reyna J, Chae J, Sepanj R, Souweidane MM, Greenfield JP. Persistent Syringomyelia After Posterior Fossa Decompression for Chiari Malformation. World Neurosurg 2020; 136:454-61. doi.org/10.1016/j.wneu.2020.01.148
Kumar A, Pruthi N, Devi BI, Gupta AK. Response of syrinx associated with Chiari i malformation to posterior fossa
decompression with or without duraplasty and correlation with functional outcome: a prospective study of 22 patients. J Neurosci Rural Pract 2018; 9:587–92. doi: 10.4103/jnrp.jnrp_10_18
Yahanda AT, Simon LE, Limbrick DD. Outcomes for various dural graft materials after posterior fossa decompression with duraplasty for Chiari malformation type I: a systematic review and meta-analysis. J Neurosurg 2021; 1(aop):1-4. doi.org/10.3171/2020.9.JNS202641
Edilen CO, Takibi OU. Cerebellar tonsillectomy with suboccipital decompression and duraplasty by small incision for Chiari I malformation (with syringomyelia): long term follow-up of 76 surgically treated cases. Turkish Neurosurg 2012; 22 :274-9.
doi.10.5137/1019-5149.JTN.4634-11.1
Botelho RV, Bittencourt LR, Rotta JM, Tufik S. The effects of posterior fossa decompressive surgery in adult patients with Chiari malformation and sleep apnea. J Neurosurg 2010; 112:800-7. doi: 10.3171/2009.7.JNS09174
Osborne-Grinter M, Arora M, Kaliaperumal C, Gallo P. Posterior fossa decompression and duraplasty with and without arachnoid preservation for the treatment of adult chiari malformation type 1: a systematic review and meta-analysis. World Neurosurg 2021; 151:e579-e598. doi: 10.1016/j.wneu.2021.04.082
Tam SK, Brodbelt A, Bolognese PA, Foroughi M Posterior fossa decompression with duraplasty in Chiari malformation type 1: a systematic review and metaanalysis. Acta Neurochir (Wien) 2021 ; 163:229-38. doi: 10.1007/s00701-020-04403-9
Published
Versions
- 2021-08-16 (3)
- 2021-08-12 (1)
How to Cite
Issue
Section
License
Copyright (c) 2021 Aurangzeb Kalhoro, Abdul Basit Sattar, Abdul Sattar M. Hashim Hashim
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles published in the Journal of Dow University of Health Sciences are distributed under the terms of the Creative Commons Attribution Non-Commercial License https://creativecommons.org/ licenses/by-nc/4.0/. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal.