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Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients.
J Neurosurg. 2013 Feb; 118(2):232-42.JN

Abstract

OBJECT

This study aims to show the relationship between clinical outcome in patients who underwent surgical decompression for Chiari malformation (CM) and postoperative imaging studies, with particular emphasis on the subarachnoid cisterns of the posterior fossa.

METHODS

One hundred seventy-seven patients with CM, including 97 with syringomyelia, underwent posterior fossa decompressive surgery. Both the dura and arachnoid were opened in 150 of these patients, and 135 underwent reduction of the cerebellar tonsils. The patients' clinical signs and symptoms were evaluated at 2 time points after surgery. Their imaging studies were analyzed specifically for the size of the retrotonsillar and subtonsillar cisterns and the syringomyelic cavities. The authors evaluated the relationship between these imaging findings and clinical parameters.

RESULTS

Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns, and enlargement of the cisterns also correlated with reduction in size of the syrinx cavities. Symptoms related to syringomyelia responded to reduction in size of the syrinx cavities.

CONCLUSIONS

Surgical decompression of the posterior fossa should aim to create relatively large subarachnoid cisterns and reduce the size of the syrinx cavity. Reduction of the cerebellar tonsils by surgical means, together with duraplasty, achieves this goal and thereby improves the clinical outcome for patients with CM. An incidental observation of the study is that obesity increases the likelihood of headache in patients with CM.

Authors+Show Affiliations

Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. ubatzdorf@mednet.ucla.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23176335

Citation

Batzdorf, Ulrich, et al. "Surgical Treatment of Chiari Malformation With and Without Syringomyelia: Experience With 177 Adult Patients." Journal of Neurosurgery, vol. 118, no. 2, 2013, pp. 232-42.
Batzdorf U, McArthur DL, Bentson JR. Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients. J Neurosurg. 2013;118(2):232-42.
Batzdorf, U., McArthur, D. L., & Bentson, J. R. (2013). Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients. Journal of Neurosurgery, 118(2), 232-42. https://doi.org/10.3171/2012.10.JNS12305
Batzdorf U, McArthur DL, Bentson JR. Surgical Treatment of Chiari Malformation With and Without Syringomyelia: Experience With 177 Adult Patients. J Neurosurg. 2013;118(2):232-42. PubMed PMID: 23176335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients. AU - Batzdorf,Ulrich, AU - McArthur,David L, AU - Bentson,John R, Y1 - 2012/11/23/ PY - 2012/11/27/entrez PY - 2012/11/28/pubmed PY - 2013/3/30/medline SP - 232 EP - 42 JF - Journal of neurosurgery JO - J Neurosurg VL - 118 IS - 2 N2 - OBJECT: This study aims to show the relationship between clinical outcome in patients who underwent surgical decompression for Chiari malformation (CM) and postoperative imaging studies, with particular emphasis on the subarachnoid cisterns of the posterior fossa. METHODS: One hundred seventy-seven patients with CM, including 97 with syringomyelia, underwent posterior fossa decompressive surgery. Both the dura and arachnoid were opened in 150 of these patients, and 135 underwent reduction of the cerebellar tonsils. The patients' clinical signs and symptoms were evaluated at 2 time points after surgery. Their imaging studies were analyzed specifically for the size of the retrotonsillar and subtonsillar cisterns and the syringomyelic cavities. The authors evaluated the relationship between these imaging findings and clinical parameters. RESULTS: Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns, and enlargement of the cisterns also correlated with reduction in size of the syrinx cavities. Symptoms related to syringomyelia responded to reduction in size of the syrinx cavities. CONCLUSIONS: Surgical decompression of the posterior fossa should aim to create relatively large subarachnoid cisterns and reduce the size of the syrinx cavity. Reduction of the cerebellar tonsils by surgical means, together with duraplasty, achieves this goal and thereby improves the clinical outcome for patients with CM. An incidental observation of the study is that obesity increases the likelihood of headache in patients with CM. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/23176335/Surgical_treatment_of_Chiari_malformation_with_and_without_syringomyelia:_experience_with_177_adult_patients_ L2 - https://thejns.org/doi/10.3171/2012.10.JNS12305 DB - PRIME DP - Unbound Medicine ER -