Tags

Type your tag names separated by a space and hit enter

Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I.
World Neurosurg. 2015 Oct; 84(4):998-1004.WN

Abstract

BACKGROUND

Small-bone-window posterior fossa decompression with duraplasty is one of the popular surgical options for Chiari malformation type I, but its efficacy is controversial and the risk factors of clinical outcome remain unclear.

METHODS

The study cohort included 152 patients with Chiari malformation type I who received small-bone-window posterior fossa decompression at Beijing Tiantan hospital from January 2008 to September 2009. All patients underwent combined surgical procedures: a small-bone-window suboccipital decompression (diameter, 2.5-3 cm) and a C1 laminectomy (1.5- to 2-cm wide) followed by a duraplasty with an autologous graft. Clinical manifestations, radiologic features, and follow-up data during a 6-year span were analyzed. Risk factors associated with outcome were investigated by the use of χ(2) analysis and logistic regression analysis.

RESULTS

The average follow-up duration was 74 months. Symptoms were improved in 126 patients (82.9%), remained stable in 21 patients (13.8%), and deteriorated in 5 patients (3.3%). There was no mortality. Postoperative magnetic resonance imaging scans were available for all patients. Preoperatively, 112 patients were associated with syringomyelia, and the follow-up magnetic resonance images showed obvious reduction of syringomyelia in 73 patients (65.2%) and no significant change in 39 patients (34.8%). In addition, enlargement of the cistern magna was observed in 92 patients (85.2%). Regression analysis indicates preoperative motor dysfunction, brainstem herniation and basilar invagination may influence the clinical outcome (P < 0.05).

CONCLUSIONS

Small-bone-window posterior fossa decompression with duraplasty is an effective and safe treatment option with a low complication rate. Motor dysfunction, brainstem herniation, and basilar invagination are predictors of poor clinical prognosis.

Authors+Show Affiliations

Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.School of Clinical Medicine, Capital Medical University, No. 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China. Electronic address: xuhuxi@sina.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25701768

Citation

Deng, Xiaofeng, et al. "Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults With Chiari Malformation Type I." World Neurosurgery, vol. 84, no. 4, 2015, pp. 998-1004.
Deng X, Yang C, Gan J, et al. Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I. World Neurosurg. 2015;84(4):998-1004.
Deng, X., Yang, C., Gan, J., Wu, L., Yang, T., Yang, J., & Xu, Y. (2015). Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I. World Neurosurgery, 84(4), 998-1004. https://doi.org/10.1016/j.wneu.2015.02.006
Deng X, et al. Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults With Chiari Malformation Type I. World Neurosurg. 2015;84(4):998-1004. PubMed PMID: 25701768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I. AU - Deng,Xiaofeng, AU - Yang,Chenlong, AU - Gan,Jiahe, AU - Wu,Liang, AU - Yang,Tao, AU - Yang,Jun, AU - Xu,Yulun, Y1 - 2015/02/18/ PY - 2014/10/06/received PY - 2015/02/01/revised PY - 2015/02/04/accepted PY - 2015/2/22/entrez PY - 2015/2/24/pubmed PY - 2016/1/12/medline KW - Chiari malformation KW - Posterior fossa decompression KW - Small bone window KW - Syringomyelia KW - Tonsillar herniation SP - 998 EP - 1004 JF - World neurosurgery JO - World Neurosurg VL - 84 IS - 4 N2 - BACKGROUND: Small-bone-window posterior fossa decompression with duraplasty is one of the popular surgical options for Chiari malformation type I, but its efficacy is controversial and the risk factors of clinical outcome remain unclear. METHODS: The study cohort included 152 patients with Chiari malformation type I who received small-bone-window posterior fossa decompression at Beijing Tiantan hospital from January 2008 to September 2009. All patients underwent combined surgical procedures: a small-bone-window suboccipital decompression (diameter, 2.5-3 cm) and a C1 laminectomy (1.5- to 2-cm wide) followed by a duraplasty with an autologous graft. Clinical manifestations, radiologic features, and follow-up data during a 6-year span were analyzed. Risk factors associated with outcome were investigated by the use of χ(2) analysis and logistic regression analysis. RESULTS: The average follow-up duration was 74 months. Symptoms were improved in 126 patients (82.9%), remained stable in 21 patients (13.8%), and deteriorated in 5 patients (3.3%). There was no mortality. Postoperative magnetic resonance imaging scans were available for all patients. Preoperatively, 112 patients were associated with syringomyelia, and the follow-up magnetic resonance images showed obvious reduction of syringomyelia in 73 patients (65.2%) and no significant change in 39 patients (34.8%). In addition, enlargement of the cistern magna was observed in 92 patients (85.2%). Regression analysis indicates preoperative motor dysfunction, brainstem herniation and basilar invagination may influence the clinical outcome (P < 0.05). CONCLUSIONS: Small-bone-window posterior fossa decompression with duraplasty is an effective and safe treatment option with a low complication rate. Motor dysfunction, brainstem herniation, and basilar invagination are predictors of poor clinical prognosis. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/25701768/Long_Term_Outcomes_After_Small_Bone_Window_Posterior_Fossa_Decompression_and_Duraplasty_in_Adults_with_Chiari_Malformation_Type_I_ DB - PRIME DP - Unbound Medicine ER -