Complex Chiari Malformation: Proposal of a New Set of Diagnostic Criteria and Outcomes After fusion Surgery.

Autor: Asghar Ali Turabi MA; Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India., Pruthi N; Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India. Electronic address: pruthi_nupur@yahoo.co.in., Bhat D; Department of Neurosurgery, RV Aster Hospital, Bengaluru, India., Bhagavatula ID; Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2021 Oct; Vol. 154, pp. e677-e682. Date of Electronic Publication: 2021 Jul 31.
DOI: 10.1016/j.wneu.2021.07.115
Abstrakt: Background: The proposal of C1-C2 fusion as a better treatment option compared with foramen magnum decompression (FMD) for the treatment of Chiari 1 malformations has led to controversy. Although FMD is a time-tested treatment option, a group of patients exists who will benefit from C1-C2 fusion. We have proposed an objective system for defining complex Chiari malformations and studied the outcomes of fusion with decompression versus decompression alone for these patients.
Methods: A total of 26 patients with complex Chiari malformations were identified using our criteria (any 4 of 7 clinicoradiological parameters). Of the 26 patients, 13 had undergone C1-C2 fusion with FMD and 13 had undergone FMD alone. They had also undergone pre- and postoperative clinicoradiological evaluations, and the outcomes were assessed using the Chicago Chiari outcome score.
Results: Of the 13 patients in the fusion group, 12 (92.3%) showed improvement compared with only 6 of 13 patients (46.2%) in the nonfusion group using the Chicago Chiari outcome score, a statistically significant difference (P = 0.036, χ 2 test). The mean hospital length of stay was longer for the fusion group (6.15 ± 1.46 days) than for the nonfusion group (4.38 ± 2.22 days; P = 0.02).
Conclusions: We have proposed a novel set of criteria for defining complex Chiari malformations. Fusion with decompression provided better outcomes than decompression alone.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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