Management of Chiari I malformation in children: effectiveness of intra-operative ultrasound for tailoring foramen magnum decompression
| Autor: | Christopher Parks, Ganesalingam Narenthiran, Benedetta Pettorini |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
musculoskeletal diseases
Male medicine.medical_specialty Decompressive Craniectomy Adolescent Decompression medicine Humans Syrinx (medicine) Foramen Magnum Child Retrospective Studies Ultrasonography Foramen magnum medicine.diagnostic_test business.industry Ultrasound Retrospective cohort study Magnetic resonance imaging General Medicine medicine.disease Magnetic Resonance Imaging Surgery Arnold-Chiari Malformation medicine.anatomical_structure Child Preschool Pediatrics Perinatology and Child Health Female Neurology (clinical) Radiology Neurosurgery business Syringomyelia |
| Zdroj: | Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 31(8) |
| ISSN: | 1433-0350 |
| Popis: | Patients with Chiari I malformation (CM-1) commonly undergo foramen magnum decompression (FMD). However, there is no consensus on how this should be achieved. An approach would be to rationalize surgical steps based on pre-operative imaging and intra-operative findings. The aim of this study is to assess the usefulness of intra-operative ultrasound scanning (IOUS) in tailoring foramen magnum decompression in children with CM-1 and whether the use of IOUS is effective in reducing the risk of complications without increasing the need for re-operation. We performed a retrospective study. IOUS was utilized during FMD: a subjective assessment was made on whether there was adequate cerebellar tonsillar and/or CSF pulsation following suboccipital craniectomy. If there was adequate pulsation, the dura was not opened. Additional data were collected including age and gender of patients, presence of pre-operative syringomyelia, intra-operative ultrasound findings, length of follow-up, complications and radiological and clinical outcome. The statistical analysis was performed with XLStat®(Addinsoft SARL™, France). Nineteen patients underwent FMD from June 2011 to December 2012. The mean age was 10.5 years; there were nine females and ten males. Eleven patients had syringomyelia at diagnosis. Based on IOUS, eight patients underwent dural decompression and 11 patients bony decompression only. One patient had a post-operative pseudomeningocoele and two patients required re-operation. There was no significant statistical difference between the two groups regarding post-operative improvement in the syrinx. We found that tailoring FMD for patients with CM-1 using intra-operative findings using ultrasound scan was useful in avoiding unnecessary manoeuvres, while not compromising on the outcome. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink