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"Triple R" tonsillar technique for the management of adult Chiari I malformation: surgical note.
Acta Neurochir (Wien). 2013 Jul; 155(7):1195-201.AN

Abstract

BACKGROUND

Chiari type I malformation is a congenital disorder that is characterized by the caudal extension of the cerebellar tonsils through the foramen magnum into the cervical canal and by a reduced posterior fossa volume.

METHODS

We report our surgical technique of reposition, reduction, or resection of the cerebellar tonsils for the management of Chiari I malformation. The procedure was performed in 22 adult patients, in three different centers, with a mean age of 37 years. Clinical complaints included headaches, nuchalgia, vertigo, and upper-limb weakness or numbness. Seven patients had cervical syringomyelia. Symptoms developed within a mean time of 36 months (range, 12-70 months).

RESULTS

The cerebellar tonsils were exposed through a dura mater-arachnoid incision at the atlanto-occipital space after a 0.5-cm rimming craniectomy of the occipital bone in all patients. In seven patients the tonsils were resected, in other seven were reduced by subpial coagulation and aspiration, and in the remaining eight patients the tonsils were repositioned after coagulating their surfaces. Three patients had also a posterior fossa arachnoid cyst that was fenestrated in two of them. All patients improved postoperatively. Syringomyelia was reduced in five of seven patients. The mean length of the follow-up period was 12 months.

CONCLUSIONS

Selective reposition, reduction, or resection of herniated cerebellar tonsils may improve symptoms in adult patients with Chiari I malformation.

Authors+Show Affiliations

Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23695377

Citation

Galarza, Marcelo, et al. ""Triple R" Tonsillar Technique for the Management of Adult Chiari I Malformation: Surgical Note." Acta Neurochirurgica, vol. 155, no. 7, 2013, pp. 1195-201.
Galarza M, Gazzeri R, Alfieri A, et al. "Triple R" tonsillar technique for the management of adult Chiari I malformation: surgical note. Acta Neurochir (Wien). 2013;155(7):1195-201.
Galarza, M., Gazzeri, R., Alfieri, A., & Martínez-Lage, J. F. (2013). "Triple R" tonsillar technique for the management of adult Chiari I malformation: surgical note. Acta Neurochirurgica, 155(7), 1195-201. https://doi.org/10.1007/s00701-013-1749-2
Galarza M, et al. "Triple R" Tonsillar Technique for the Management of Adult Chiari I Malformation: Surgical Note. Acta Neurochir (Wien). 2013;155(7):1195-201. PubMed PMID: 23695377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Triple R" tonsillar technique for the management of adult Chiari I malformation: surgical note. AU - Galarza,Marcelo, AU - Gazzeri,Roberto, AU - Alfieri,Alex, AU - Martínez-Lage,Juan F, Y1 - 2013/05/22/ PY - 2013/02/18/received PY - 2013/04/29/accepted PY - 2013/5/23/entrez PY - 2013/5/23/pubmed PY - 2014/3/22/medline SP - 1195 EP - 201 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 155 IS - 7 N2 - BACKGROUND: Chiari type I malformation is a congenital disorder that is characterized by the caudal extension of the cerebellar tonsils through the foramen magnum into the cervical canal and by a reduced posterior fossa volume. METHODS: We report our surgical technique of reposition, reduction, or resection of the cerebellar tonsils for the management of Chiari I malformation. The procedure was performed in 22 adult patients, in three different centers, with a mean age of 37 years. Clinical complaints included headaches, nuchalgia, vertigo, and upper-limb weakness or numbness. Seven patients had cervical syringomyelia. Symptoms developed within a mean time of 36 months (range, 12-70 months). RESULTS: The cerebellar tonsils were exposed through a dura mater-arachnoid incision at the atlanto-occipital space after a 0.5-cm rimming craniectomy of the occipital bone in all patients. In seven patients the tonsils were resected, in other seven were reduced by subpial coagulation and aspiration, and in the remaining eight patients the tonsils were repositioned after coagulating their surfaces. Three patients had also a posterior fossa arachnoid cyst that was fenestrated in two of them. All patients improved postoperatively. Syringomyelia was reduced in five of seven patients. The mean length of the follow-up period was 12 months. CONCLUSIONS: Selective reposition, reduction, or resection of herniated cerebellar tonsils may improve symptoms in adult patients with Chiari I malformation. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/23695377/"Triple_R"_tonsillar_technique_for_the_management_of_adult_Chiari_I_malformation:_surgical_note_ L2 - https://dx.doi.org/10.1007/s00701-013-1749-2 DB - PRIME DP - Unbound Medicine ER -