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Appropriate surgical procedures for Chiari type 1 malformation and associated syrinx based on radiological characteristics of the craniovertebral junction.
Neurosurg Rev. 2020 Apr; 43(2):575-580.NR

Abstract

Several surgical procedures can be applied for syrinx associated with Chiari type 1 malformation; however, it remains controversial as to which approach is the most effective. Here, we evaluated the indications and limitations of foramen magnum decompression (FMD) with or without dural plasty. Forty patients with Chiari type 1 malformation were surgically treated and followed up for > 12 months. Thirty-two patients (80.0%) underwent FMD with removal of only the outer dura mater layer, while eight patients underwent FMD with dural plasty. We evaluated surgery-related complications and preoperative radiological findings affecting syrinx shrinkage rates. Post-surgery, the mean syrinx shrinkage rates were 0.32 ± 0.44 in the outer layer-removal group and 0.72 ± 0.27 in the dural plasty group (P = 0.012). Surgery-related complications were less frequent, but reoperation was more frequent, in the outer layer-removal group. The extent of tonsillar descent significantly affected syrinx shrinkage in FMD with outer layer removal (P = 0.042). The outcomes of both approaches in patients with tonsillar descent < 10.0 mm were similar. The dura mater in the posterior fossa was thin, necessitating dural plasty with FMD, while the spinal dura was sufficiently thick for removal of the outer layer in the Chiari patients. These histological differences corresponded with the inferior margin of the cerebellar tonsil. Recognizing the appropriate surgical indication for achieving good post-procedural outcomes is necessary for reducing complications and improving outcomes of FMD for Chiari type 1 malformations.

Authors+Show Affiliations

Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. kitoh@shinshu-u.ac.jp.Division of Neuropathology, Department of Brain Disease Research, Center for Clinical Research, Shinshu University School of Medicine, Matsumoto, Japan.Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30684108

Citation

Ito, Kiyoshi, et al. "Appropriate Surgical Procedures for Chiari Type 1 Malformation and Associated Syrinx Based On Radiological Characteristics of the Craniovertebral Junction." Neurosurgical Review, vol. 43, no. 2, 2020, pp. 575-580.
Ito K, Yamada M, Horiuchi T, et al. Appropriate surgical procedures for Chiari type 1 malformation and associated syrinx based on radiological characteristics of the craniovertebral junction. Neurosurg Rev. 2020;43(2):575-580.
Ito, K., Yamada, M., Horiuchi, T., & Hongo, K. (2020). Appropriate surgical procedures for Chiari type 1 malformation and associated syrinx based on radiological characteristics of the craniovertebral junction. Neurosurgical Review, 43(2), 575-580. https://doi.org/10.1007/s10143-019-01079-3
Ito K, et al. Appropriate Surgical Procedures for Chiari Type 1 Malformation and Associated Syrinx Based On Radiological Characteristics of the Craniovertebral Junction. Neurosurg Rev. 2020;43(2):575-580. PubMed PMID: 30684108.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Appropriate surgical procedures for Chiari type 1 malformation and associated syrinx based on radiological characteristics of the craniovertebral junction. AU - Ito,Kiyoshi, AU - Yamada,Mitsunori, AU - Horiuchi,Tetsuyoshi, AU - Hongo,Kazuhiro, Y1 - 2019/01/25/ PY - 2018/03/27/received PY - 2019/01/15/accepted PY - 2018/12/06/revised PY - 2019/1/27/pubmed PY - 2020/10/9/medline PY - 2019/1/27/entrez KW - Chiari type 1 malformation KW - Clinical outcome KW - Radiological characteristics KW - Surgical approach SP - 575 EP - 580 JF - Neurosurgical review JO - Neurosurg Rev VL - 43 IS - 2 N2 - Several surgical procedures can be applied for syrinx associated with Chiari type 1 malformation; however, it remains controversial as to which approach is the most effective. Here, we evaluated the indications and limitations of foramen magnum decompression (FMD) with or without dural plasty. Forty patients with Chiari type 1 malformation were surgically treated and followed up for > 12 months. Thirty-two patients (80.0%) underwent FMD with removal of only the outer dura mater layer, while eight patients underwent FMD with dural plasty. We evaluated surgery-related complications and preoperative radiological findings affecting syrinx shrinkage rates. Post-surgery, the mean syrinx shrinkage rates were 0.32 ± 0.44 in the outer layer-removal group and 0.72 ± 0.27 in the dural plasty group (P = 0.012). Surgery-related complications were less frequent, but reoperation was more frequent, in the outer layer-removal group. The extent of tonsillar descent significantly affected syrinx shrinkage in FMD with outer layer removal (P = 0.042). The outcomes of both approaches in patients with tonsillar descent < 10.0 mm were similar. The dura mater in the posterior fossa was thin, necessitating dural plasty with FMD, while the spinal dura was sufficiently thick for removal of the outer layer in the Chiari patients. These histological differences corresponded with the inferior margin of the cerebellar tonsil. Recognizing the appropriate surgical indication for achieving good post-procedural outcomes is necessary for reducing complications and improving outcomes of FMD for Chiari type 1 malformations. SN - 1437-2320 UR - https://www.unboundmedicine.com/medline/citation/30684108/Appropriate_surgical_procedures_for_Chiari_type_1_malformation_and_associated_syrinx_based_on_radiological_characteristics_of_the_craniovertebral_junction_ L2 - https://dx.doi.org/10.1007/s10143-019-01079-3 DB - PRIME DP - Unbound Medicine ER -