Surgical management of Chiari II malformation: a systematic review of literature.

Autor: Vencio RCC; Department of Medicine, Pontifical Catholic University of Goiás, Goiânia, Brazil., Lino-Filho AM; Department of Neurological Surgery, Clinics Hospital, School of Medicine, Federal University of Goiás, Goiânia, Brazil., Bonfim RCF; Department of Medicine, Pontifical Catholic University of Goiás, Goiânia, Brazil., Pereira NM; Department of Neurological Surgery, Children's Hospital, Goiânia, Brazil., Franco CL; Department of Neurological Surgery, Children's Hospital, Goiânia, Brazil., Ribeiro PRJ; Department of Neurological Surgery, Children's Hospital, Goiânia, Brazil.; Department of Neurological Surgery, Clinics Hospital, School of Medicine, Federal University of Goiás, Goiânia, Brazil., Morais BA; Department of Neurological Surgery, Children's Hospital, Goiânia, Brazil. dra.barbaramorais@gmail.com.
Jazyk: angličtina
Zdroj: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2024 Jul; Vol. 40 (7), pp. 2093-2100. Date of Electronic Publication: 2024 Mar 27.
DOI: 10.1007/s00381-024-06368-x
Abstrakt: Purpose: Chiari II malformation (CM-II) is a congenital malformation of the posterior fossa associated with myelomeningocele. Of the symptomatic patients, 10-33% require surgical treatment. To this date, there is not a consensus about the best surgical technique, and whether to do duroplasty.
Methods: A literature search of the PubMed database and crossed references was performed, per PRISMA guidelines. Data regarding demographic features, extent of cervicomedullary deformity, clinical presentation, surgical techniques, and clinical outcomes were extracted. Pearson's chi-squared test was applied. The p-values under 0.05 were considered statistically significant.
Results: Twenty studies (N = 330) were analyzed. C3 and C4 levels represented 56.4% of the lowest tonsil displacement. The most reported symptom was dysphagia/swallowing dysfunction (53.8%). Suboccipital craniectomy (SOC) and cervical spine expansion (CSE) with duroplasty were the most reported technique. Dural augmentation was performed in 57.4% of the patients. After surgery, 59.6% observed an improvement in symptoms and quality of life, 12.5% were unchanged, and 27.8% had a worsened clinical status. The mortality rate was 2.5% during the first month after surgery, and 17.4% at the last follow-up evaluation. Patients who underwent CSE presented a better clinical outcome (p = 0.002). The SOC procedure could not be correlated with symptom improvement (p = 0.06).
Conclusion: CM-II is associated with high morbidity and mortality. An early onset symptomatic CM-II demands intervention, which provided an improvement of outcome in most patients included in this review. The best surgical technique and the exact effect of the surgical management of CM-II on mortality are not yet clear.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: