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Extra-arachnoidal cranio-cervical decompression for syringomyelia associated with Chiari I malformation in adults: technique assessment.
Acta Neurochir (Wien). 2007 Oct; 149(10):1015-22; discussion 1022-3.AN

Abstract

BACKGROUND

The osteo-dural decompression of the cerebellar tonsils at the cranio-cervical junction is generally considered the most effective treatment for syringomyelia-Chiari I complex. However much controversy concerning a great number of surgical adjuvants to the standard bony decompression is still present. In this work an extra-arachnoidal cranio-cervical decompression (CCD) without duroplasty is described and the surgical results are reported.

METHOD

Between 2000 and 2005, 24 adult patients underwent surgery for symptomatic syringomyelia-Chiari I complex not associated with hydrocephalus. In all cases, the surgical procedure consisted of a limited suboccipital craniectomy and laminectomy of C1 (when necessary C2 as well) followed by dural opening leaving the arachnoid membrane intact. The dura mater is left open and stitched laterally to the muscles.

FINDINGS

With a mean clinical long term follow-up of 44 months (range, 12-78 mo), neurological disturbances improved in 21 of 24 patients (87.5%) as result of extra-arachnoidal CCD. The postoperative complications occurred when the arachnoid was accidentally violated (4 cases, 16.6%). The complications included aseptic meningitis (one patient), nucal pseudomeningocele (two patients) and postoperative hydrocephalus requiring a ventriculoperitoneal shunt (one patient). Finally, one patient received an additional C2 laminectomy in order to obtain symptoms improvement and syrinx shrinkage. Postoperative MRI studies demonstrated that the syrinx decreased in size or collapsed in 20 patients (83.3%) and stabilized in 4 (16.7%).

CONCLUSIONS

The extra-arachnoidal CCD is a safe and effective treatment for syringomyelia associated with Chiari I malformation in adults without intraoperative evidence of adhesive arachnoiditis. However a larger number of patients and longer follow-up will be necessary to determine the efficacy of extra-arachnoidal CCD.

Authors+Show Affiliations

Neurosurgical Department, University of Florence, Italy. perrinipaolo@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17712512

Citation

Perrini, P, et al. "Extra-arachnoidal Cranio-cervical Decompression for Syringomyelia Associated With Chiari I Malformation in Adults: Technique Assessment." Acta Neurochirurgica, vol. 149, no. 10, 2007, pp. 1015-22; discussion 1022-3.
Perrini P, Benedetto N, Tenenbaum R, et al. Extra-arachnoidal cranio-cervical decompression for syringomyelia associated with Chiari I malformation in adults: technique assessment. Acta Neurochir (Wien). 2007;149(10):1015-22; discussion 1022-3.
Perrini, P., Benedetto, N., Tenenbaum, R., & Di Lorenzo, N. (2007). Extra-arachnoidal cranio-cervical decompression for syringomyelia associated with Chiari I malformation in adults: technique assessment. Acta Neurochirurgica, 149(10), 1015-22; discussion 1022-3.
Perrini P, et al. Extra-arachnoidal Cranio-cervical Decompression for Syringomyelia Associated With Chiari I Malformation in Adults: Technique Assessment. Acta Neurochir (Wien). 2007;149(10):1015-22; discussion 1022-3. PubMed PMID: 17712512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extra-arachnoidal cranio-cervical decompression for syringomyelia associated with Chiari I malformation in adults: technique assessment. AU - Perrini,P, AU - Benedetto,N, AU - Tenenbaum,R, AU - Di Lorenzo,N, Y1 - 2007/08/23/ PY - 2007/03/12/received PY - 2007/07/24/accepted PY - 2007/8/23/pubmed PY - 2008/1/8/medline PY - 2007/8/23/entrez SP - 1015-22; discussion 1022-3 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 149 IS - 10 N2 - BACKGROUND: The osteo-dural decompression of the cerebellar tonsils at the cranio-cervical junction is generally considered the most effective treatment for syringomyelia-Chiari I complex. However much controversy concerning a great number of surgical adjuvants to the standard bony decompression is still present. In this work an extra-arachnoidal cranio-cervical decompression (CCD) without duroplasty is described and the surgical results are reported. METHOD: Between 2000 and 2005, 24 adult patients underwent surgery for symptomatic syringomyelia-Chiari I complex not associated with hydrocephalus. In all cases, the surgical procedure consisted of a limited suboccipital craniectomy and laminectomy of C1 (when necessary C2 as well) followed by dural opening leaving the arachnoid membrane intact. The dura mater is left open and stitched laterally to the muscles. FINDINGS: With a mean clinical long term follow-up of 44 months (range, 12-78 mo), neurological disturbances improved in 21 of 24 patients (87.5%) as result of extra-arachnoidal CCD. The postoperative complications occurred when the arachnoid was accidentally violated (4 cases, 16.6%). The complications included aseptic meningitis (one patient), nucal pseudomeningocele (two patients) and postoperative hydrocephalus requiring a ventriculoperitoneal shunt (one patient). Finally, one patient received an additional C2 laminectomy in order to obtain symptoms improvement and syrinx shrinkage. Postoperative MRI studies demonstrated that the syrinx decreased in size or collapsed in 20 patients (83.3%) and stabilized in 4 (16.7%). CONCLUSIONS: The extra-arachnoidal CCD is a safe and effective treatment for syringomyelia associated with Chiari I malformation in adults without intraoperative evidence of adhesive arachnoiditis. However a larger number of patients and longer follow-up will be necessary to determine the efficacy of extra-arachnoidal CCD. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/17712512/Extra_arachnoidal_cranio_cervical_decompression_for_syringomyelia_associated_with_Chiari_I_malformation_in_adults:_technique_assessment_ L2 - https://dx.doi.org/10.1007/s00701-007-1276-0 DB - PRIME DP - Unbound Medicine ER -