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Intraoperative ultrasonography used to determine the extent of surgery necessary during posterior fossa decompression in children with Chiari malformation type I.
J Neurosurg. 2006 Jul; 105(1 Suppl):26-32.JN

Abstract

OBJECT

In this retrospective analysis, the authors report a prospective study in which intraoperative ultrasonography was used to determine the extent of surgery necessary during posterior fossa decompression surgery for Chiari malformation Type I (CM-I) in children.

METHODS

Between 1995 and 2003, posterior fossa decompression was performed in 149 patients (mean 5.9 years of age, range 9 months-18 years of age) with CM-I. Of these, 130 underwent intraoperative ultrasonographic evaluation of the craniocervical junction (CCJ) and 15 did not. Four patients with craniosynostosis were excluded from the study. Duraplasty and tonsillar shrinkage were performed when ultrasonographic evidence showed significant decreases in cerebrospinal fluid (CSF) or abnormal tonsillar piston action. Surgical success was determined on the basis of clinical outcome and need for reoperation. One hundred and twenty-four (95.5%) of the children had successful outcomes following surgery and six (4.5%) experienced continued or worsening symptoms requiring reoperation. Forty patients did not undergo duraplasty because the ultrasonography evidence showed adequate decompression with bone removal alone. Of 90 patients with significant compression, decreased CSF dynamics, and/or abnormal tonsillar piston-like action at the CCJ, 85 underwent duraplasty and tonsillar shrinkage and five did not for various reasons. One patient in whom the dura mater was violated accidentally during bone decompression subsequently underwent duraplasty. Hospital stays lasted 6.4 +/- 3.9 days (mean +/- standard deviation) when duraplasty was performed compared with 4.3 +/- 1.1 days when it was not (p < 0.0003). After bone decompression alone, no patient experienced complications. After duraplasty, 12 patients experienced complications and had headaches, nausea, and pain more often than patients who underwent bone decompression alone. Mean tonsillar descent was 11 +/- 4 mm after bone decompression only and 13.9 +/- 4.9 mm after duraplasty, with tonsillar shrinkage (p < 0.0003) seen on magnetic resonance imaging.

CONCLUSIONS

In patients who undergo decompressive surgery for CM-I, intraoperative ultrasonography may be a useful tool to aid the surgeon in deciding whether to opt for bone removal only or bone removal plus duraplasty and tonsillar shrinkage.

Authors+Show Affiliations

Department of Neurosurgery, University of Cincinnati College of Medicine, Ohio, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16871867

Citation

Yeh, David D., et al. "Intraoperative Ultrasonography Used to Determine the Extent of Surgery Necessary During Posterior Fossa Decompression in Children With Chiari Malformation Type I." Journal of Neurosurgery, vol. 105, no. 1 Suppl, 2006, pp. 26-32.
Yeh DD, Koch B, Crone KR. Intraoperative ultrasonography used to determine the extent of surgery necessary during posterior fossa decompression in children with Chiari malformation type I. J Neurosurg. 2006;105(1 Suppl):26-32.
Yeh, D. D., Koch, B., & Crone, K. R. (2006). Intraoperative ultrasonography used to determine the extent of surgery necessary during posterior fossa decompression in children with Chiari malformation type I. Journal of Neurosurgery, 105(1 Suppl), 26-32.
Yeh DD, Koch B, Crone KR. Intraoperative Ultrasonography Used to Determine the Extent of Surgery Necessary During Posterior Fossa Decompression in Children With Chiari Malformation Type I. J Neurosurg. 2006;105(1 Suppl):26-32. PubMed PMID: 16871867.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative ultrasonography used to determine the extent of surgery necessary during posterior fossa decompression in children with Chiari malformation type I. AU - Yeh,David D, AU - Koch,Bernadette, AU - Crone,Kerry R, PY - 2006/7/29/pubmed PY - 2006/9/13/medline PY - 2006/7/29/entrez SP - 26 EP - 32 JF - Journal of neurosurgery JO - J Neurosurg VL - 105 IS - 1 Suppl N2 - OBJECT: In this retrospective analysis, the authors report a prospective study in which intraoperative ultrasonography was used to determine the extent of surgery necessary during posterior fossa decompression surgery for Chiari malformation Type I (CM-I) in children. METHODS: Between 1995 and 2003, posterior fossa decompression was performed in 149 patients (mean 5.9 years of age, range 9 months-18 years of age) with CM-I. Of these, 130 underwent intraoperative ultrasonographic evaluation of the craniocervical junction (CCJ) and 15 did not. Four patients with craniosynostosis were excluded from the study. Duraplasty and tonsillar shrinkage were performed when ultrasonographic evidence showed significant decreases in cerebrospinal fluid (CSF) or abnormal tonsillar piston action. Surgical success was determined on the basis of clinical outcome and need for reoperation. One hundred and twenty-four (95.5%) of the children had successful outcomes following surgery and six (4.5%) experienced continued or worsening symptoms requiring reoperation. Forty patients did not undergo duraplasty because the ultrasonography evidence showed adequate decompression with bone removal alone. Of 90 patients with significant compression, decreased CSF dynamics, and/or abnormal tonsillar piston-like action at the CCJ, 85 underwent duraplasty and tonsillar shrinkage and five did not for various reasons. One patient in whom the dura mater was violated accidentally during bone decompression subsequently underwent duraplasty. Hospital stays lasted 6.4 +/- 3.9 days (mean +/- standard deviation) when duraplasty was performed compared with 4.3 +/- 1.1 days when it was not (p < 0.0003). After bone decompression alone, no patient experienced complications. After duraplasty, 12 patients experienced complications and had headaches, nausea, and pain more often than patients who underwent bone decompression alone. Mean tonsillar descent was 11 +/- 4 mm after bone decompression only and 13.9 +/- 4.9 mm after duraplasty, with tonsillar shrinkage (p < 0.0003) seen on magnetic resonance imaging. CONCLUSIONS: In patients who undergo decompressive surgery for CM-I, intraoperative ultrasonography may be a useful tool to aid the surgeon in deciding whether to opt for bone removal only or bone removal plus duraplasty and tonsillar shrinkage. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/16871867/Intraoperative_ultrasonography_used_to_determine_the_extent_of_surgery_necessary_during_posterior_fossa_decompression_in_children_with_Chiari_malformation_type_I_ L2 - https://thejns.org/doi/10.3171/ped.2006.105.1.26 DB - PRIME DP - Unbound Medicine ER -