Surgical Treatment in Symptomatic Chiari Malformation Type I: A Series of 25 Adult Patients Treated with Cerebellar Tonsil Shrinkage
| Autor: | Alessia Imperato, Alessandro E. P. Villa, Natale Francaviglia, Massimiliano Visocchi, Domenico Gerardo Iacopino, Rosario Maugeri |
|---|---|
| Přispěvatelé: | Visocchi M., Villa A., Imperato A., Maugeri R., Iacopino D., Francaviglia N. |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Decompressive Craniectomy medicine.medical_specialty Cerebellar Vermi 030218 nuclear medicine & medical imaging 03 medical and health sciences Chiari malformation type I 0302 clinical medicine CHIARI MALFORMATION TYPE I Electrocoagulation medicine Duraplasty In patient Surgical treatment Cerebellar tonsil shrinkage Adult patients Settore MED/27 - Neurochirurgia business.industry Laminectomy Decompression Surgical medicine.disease Magnetic Resonance Imaging Syringomyelia Arnold-Chiari Malformation Surgery Posterior fossa decompression Treatment Outcome medicine.anatomical_structure Radiological weapon Cerebellar tonsil Female business 030217 neurology & neurosurgery Human |
| Zdroj: | Acta Neurochirurgica Supplement ISBN: 9783319625140 |
| DOI: | 10.1007/978-3-319-62515-7_18 |
| Popis: | Background: 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 experience, describing our technique and critically evaluating the clinical results. Methods: Between 2012 and 2016, 25 patients (15 female and 10 male; mean age 39.2 years) underwent posterior fossa decompression for Chiari malformation type I. Their clinical complaints included headache, nuchalgia, upper limb weakness or numbness, instability, dizziness and diplopia. Syringomyelia was present in 12 patients (48%). Suboccipital craniectomy was completed in all cases with C1 laminectomy and shrinkage of the cerebellar tonsils by bipolar coagulation; duraplasty was performed with a suturable dura substitute. Results: Gratifying results were observed in our series. Symptoms and signs were resolved in 52% of patients, and 20% of patients had an improvement in their preoperative deficits. The symptoms of six patients (24%) were essentially unchanged, and one patient (4%) deteriorated despite undergoing surgery. Generally, patients with syringomyelia on magnetic resonance imaging (MRI) showed less symptomatic improvement after surgery. The syrinx disappeared in seven of 12 patients, and complications occurred in three patients (12%). Conclusion: Cerebellar tonsil reduction and restoration of cerebrospinal fluid (CSF) circulation provided clinical improvement and a stable reduction in the syrinx size in the vast majority of treated patients, with a low rate of complications. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|