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Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression.
Acta Neurochir (Wien). 2007 Jan; 149(1):41-50; discussion 50.AN

Abstract

BACKGROUND

Chiari I malformation with atlantoaxial dislocation may cause both posterior and anterior cervicomedullary compression. We studied the clinicoradiological features and surgical outcome in patients having Chiari I malformation with atlantoaxial dislocation.

METHOD

Thirty-nine patients with Chiari I malformation with atlanto-axial dislocation underwent preoperative and follow-up neurological status assessment. In Chiari I malformation with reducible atlanto-axial dislocation (n = 11), a direct posterior stabilization was done. In Chiari I malformation with irreducible atlanto-axial dislocation (n = 28), a single stage transoral decompression with posterior stabilization and/or posterior decompression and duraplasty were done in 18 patients. In 10 patients, only posterior decompression and/or posterior stabilization was performed. Seven among the latter patients subsequently deteriorated and required transoral decompression. Comparison of mean neurological status scores of patients with Chiari I malformation with irreducible atlanto-axial dislocation who underwent single stage transoral decompression with posterior stabilization versus the posterior procedure alone was done using T-test and proportional significance also calculated.

FINDINGS

Patients with Chiari I malformation with atlanto-axial dislocation have a high incidence of long tract signs and sphincteric disturbances with a decrease in the mean foramen magnum diameter. The mean neurological status scores of patients with Chiari I malformation with irreducible atlanto-axial dislocation who underwent single stage transoral decompression with posterior stabilization were significantly better than those patients who underwent the posterior procedure alone. The latter patients also showed significant clinical improvement following transoral decompression. In the presence of Chiari I malformation with reducible atlanto-axial dislocation, reduction and stabilization of atlanto-axial dislocation resulted in neurological improvement. The follow up neurological status scores of these patients improved after surgical intervention even in the presence of poor preoperative grades.

CONCLUSIONS

Patients with Chiari I malformation should be investigated for the presence of atlanto-axial dislocation. In case atlantoaxial dislocation coexists, priority must be given to relieving anterior cervicomedullary compression.

Authors+Show Affiliations

Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. sbehari@sgpgi.ac.inNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17131067

Citation

Behari, S, et al. "Chiari I Malformation Associated With Atlanto-axial Dislocation: Focussing On the Anterior Cervico-medullary Compression." Acta Neurochirurgica, vol. 149, no. 1, 2007, pp. 41-50; discussion 50.
Behari S, Kalra SK, Kiran Kumar MV, et al. Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression. Acta Neurochir (Wien). 2007;149(1):41-50; discussion 50.
Behari, S., Kalra, S. K., Kiran Kumar, M. V., Salunke, P., Jaiswal, A. K., & Jain, V. K. (2007). Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression. Acta Neurochirurgica, 149(1), 41-50; discussion 50.
Behari S, et al. Chiari I Malformation Associated With Atlanto-axial Dislocation: Focussing On the Anterior Cervico-medullary Compression. Acta Neurochir (Wien). 2007;149(1):41-50; discussion 50. PubMed PMID: 17131067.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression. AU - Behari,S, AU - Kalra,S K, AU - Kiran Kumar,M V, AU - Salunke,P, AU - Jaiswal,A K, AU - Jain,V K, Y1 - 2006/11/27/ PY - 2006/04/06/received PY - 2006/09/19/accepted PY - 2006/11/30/pubmed PY - 2007/4/4/medline PY - 2006/11/30/entrez SP - 41-50; discussion 50 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 149 IS - 1 N2 - BACKGROUND: Chiari I malformation with atlantoaxial dislocation may cause both posterior and anterior cervicomedullary compression. We studied the clinicoradiological features and surgical outcome in patients having Chiari I malformation with atlantoaxial dislocation. METHOD: Thirty-nine patients with Chiari I malformation with atlanto-axial dislocation underwent preoperative and follow-up neurological status assessment. In Chiari I malformation with reducible atlanto-axial dislocation (n = 11), a direct posterior stabilization was done. In Chiari I malformation with irreducible atlanto-axial dislocation (n = 28), a single stage transoral decompression with posterior stabilization and/or posterior decompression and duraplasty were done in 18 patients. In 10 patients, only posterior decompression and/or posterior stabilization was performed. Seven among the latter patients subsequently deteriorated and required transoral decompression. Comparison of mean neurological status scores of patients with Chiari I malformation with irreducible atlanto-axial dislocation who underwent single stage transoral decompression with posterior stabilization versus the posterior procedure alone was done using T-test and proportional significance also calculated. FINDINGS: Patients with Chiari I malformation with atlanto-axial dislocation have a high incidence of long tract signs and sphincteric disturbances with a decrease in the mean foramen magnum diameter. The mean neurological status scores of patients with Chiari I malformation with irreducible atlanto-axial dislocation who underwent single stage transoral decompression with posterior stabilization were significantly better than those patients who underwent the posterior procedure alone. The latter patients also showed significant clinical improvement following transoral decompression. In the presence of Chiari I malformation with reducible atlanto-axial dislocation, reduction and stabilization of atlanto-axial dislocation resulted in neurological improvement. The follow up neurological status scores of these patients improved after surgical intervention even in the presence of poor preoperative grades. CONCLUSIONS: Patients with Chiari I malformation should be investigated for the presence of atlanto-axial dislocation. In case atlantoaxial dislocation coexists, priority must be given to relieving anterior cervicomedullary compression. SN - 0001-6268 UR - https://www.unboundmedicine.com/medline/citation/17131067/Chiari_I_malformation_associated_with_atlanto_axial_dislocation:_focussing_on_the_anterior_cervico_medullary_compression_ L2 - https://dx.doi.org/10.1007/s00701-006-1047-3 DB - PRIME DP - Unbound Medicine ER -