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Posterior fossa decompression for Chiari malformation type I: clinical and radiological presentation, outcome and complications in a retrospective series of 105 procedures.
Acta Neurol Belg. 2019 Jun; 119(2):245-252.AN

Abstract

OBJECTIVE

Determining clinical and radiological characteristics, complication rates and outcome for patients undergoing posterior fossa decompression (PFD) and duraplasty for Chiari malformation type I (CM-I).

METHODS AND MATERIALS

Retrospective, single-university hospital study of all PFDs for CM-I between January 1995 and December 2016.

RESULTS

PFD was performed in 105 patients with CM-I (n = 105), of whom 62 suffered from associated syringomyelia and 37 were pediatric cases. There was a female preponderance in the syringomyelia, non-syringomyelia, pediatric and adult groups (62.9%, 65.1%, 54.1% and 69.1%, respectively). Mean age at diagnosis was higher in the syringomyelia group (32.3 versus 26.9 years, p = 0.06) and in both groups delay for diagnosis was long (33.4 and 47.1 months, p = 0.50). Headache during Valsalva maneuver and on exertion was significantly more present in the non-syringomyelia group (27.9% versus 16.1%, p < 0.0001 and 39.5% versus 11.3%, p = 0.0009); cranial nerve dysfunction and cerebellar signs did not differ significantly (p = 0.07 and p = 0.53). Spinal cord syndrome was significantly more present in the syringomyelia group (72.6% versus 25.6%, p < 0.0001). Scoliosis was present in five patients, of whom four had syringomyelia. Duraplasty was performed in 101 surgeries. For 100 patients, PFD was the primary treatment of CM-I; 2 patients had previously undergone syrinx drainage and 3 ventriculoperitoneal shunting for hydrocephalus. Only one patient presented with hydrocephalus. Duraplasty (n = 101) was complicated by CSF leak in 4.0% (n = 4), symptomatic pseudomeningocele in 4.0% (n = 4), aseptic meningitis in 2.0% (n = 2) and hydrocephalus in 1.0% (n = 1). Osseous decompression without duraplasty was performed in only four highly selected patients, not allowing a comparative analysis with duraplasty. Post-operative symptom improvement is reported for 67.3% of all patients and stabilization of symptoms in 23.9%. Symptom improvement was significantly more frequent in the non-syringomyelia group (p = 0.03). Outcome seemed similarly good in the pediatric and the adult groups.

CONCLUSION

PFD performed with duraplasty is a safe procedure. The majority of patients do report symptom stabilization or improvement. Non-syringomyelia patients reported significantly more frequent improvement of clinical symptoms.

Authors+Show Affiliations

Department of Neurosurgery, University Hospitals, Leuven, Belgium. devliegerjan@gmail.com.Department of Neurosurgery, University Hospitals, Leuven, Belgium.Department of Neurosurgery, University Hospitals, Leuven, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30737652

Citation

De Vlieger, J, et al. "Posterior Fossa Decompression for Chiari Malformation Type I: Clinical and Radiological Presentation, Outcome and Complications in a Retrospective Series of 105 Procedures." Acta Neurologica Belgica, vol. 119, no. 2, 2019, pp. 245-252.
De Vlieger J, Dejaegher J, Van Calenbergh F. Posterior fossa decompression for Chiari malformation type I: clinical and radiological presentation, outcome and complications in a retrospective series of 105 procedures. Acta Neurol Belg. 2019;119(2):245-252.
De Vlieger, J., Dejaegher, J., & Van Calenbergh, F. (2019). Posterior fossa decompression for Chiari malformation type I: clinical and radiological presentation, outcome and complications in a retrospective series of 105 procedures. Acta Neurologica Belgica, 119(2), 245-252. https://doi.org/10.1007/s13760-019-01086-7
De Vlieger J, Dejaegher J, Van Calenbergh F. Posterior Fossa Decompression for Chiari Malformation Type I: Clinical and Radiological Presentation, Outcome and Complications in a Retrospective Series of 105 Procedures. Acta Neurol Belg. 2019;119(2):245-252. PubMed PMID: 30737652.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior fossa decompression for Chiari malformation type I: clinical and radiological presentation, outcome and complications in a retrospective series of 105 procedures. AU - De Vlieger,J, AU - Dejaegher,J, AU - Van Calenbergh,F, Y1 - 2019/02/08/ PY - 2018/05/21/received PY - 2019/01/25/accepted PY - 2019/2/10/pubmed PY - 2019/12/27/medline PY - 2019/2/10/entrez KW - Chiari malformation type I KW - Clinical presentation KW - Posterior fossa decompression KW - Safety SP - 245 EP - 252 JF - Acta neurologica Belgica JO - Acta Neurol Belg VL - 119 IS - 2 N2 - OBJECTIVE: Determining clinical and radiological characteristics, complication rates and outcome for patients undergoing posterior fossa decompression (PFD) and duraplasty for Chiari malformation type I (CM-I). METHODS AND MATERIALS: Retrospective, single-university hospital study of all PFDs for CM-I between January 1995 and December 2016. RESULTS: PFD was performed in 105 patients with CM-I (n = 105), of whom 62 suffered from associated syringomyelia and 37 were pediatric cases. There was a female preponderance in the syringomyelia, non-syringomyelia, pediatric and adult groups (62.9%, 65.1%, 54.1% and 69.1%, respectively). Mean age at diagnosis was higher in the syringomyelia group (32.3 versus 26.9 years, p = 0.06) and in both groups delay for diagnosis was long (33.4 and 47.1 months, p = 0.50). Headache during Valsalva maneuver and on exertion was significantly more present in the non-syringomyelia group (27.9% versus 16.1%, p < 0.0001 and 39.5% versus 11.3%, p = 0.0009); cranial nerve dysfunction and cerebellar signs did not differ significantly (p = 0.07 and p = 0.53). Spinal cord syndrome was significantly more present in the syringomyelia group (72.6% versus 25.6%, p < 0.0001). Scoliosis was present in five patients, of whom four had syringomyelia. Duraplasty was performed in 101 surgeries. For 100 patients, PFD was the primary treatment of CM-I; 2 patients had previously undergone syrinx drainage and 3 ventriculoperitoneal shunting for hydrocephalus. Only one patient presented with hydrocephalus. Duraplasty (n = 101) was complicated by CSF leak in 4.0% (n = 4), symptomatic pseudomeningocele in 4.0% (n = 4), aseptic meningitis in 2.0% (n = 2) and hydrocephalus in 1.0% (n = 1). Osseous decompression without duraplasty was performed in only four highly selected patients, not allowing a comparative analysis with duraplasty. Post-operative symptom improvement is reported for 67.3% of all patients and stabilization of symptoms in 23.9%. Symptom improvement was significantly more frequent in the non-syringomyelia group (p = 0.03). Outcome seemed similarly good in the pediatric and the adult groups. CONCLUSION: PFD performed with duraplasty is a safe procedure. The majority of patients do report symptom stabilization or improvement. Non-syringomyelia patients reported significantly more frequent improvement of clinical symptoms. SN - 2240-2993 UR - https://www.unboundmedicine.com/medline/citation/30737652/Posterior_fossa_decompression_for_Chiari_malformation_type_I:_clinical_and_radiological_presentation_outcome_and_complications_in_a_retrospective_series_of_105_procedures_ L2 - https://dx.doi.org/10.1007/s13760-019-01086-7 DB - PRIME DP - Unbound Medicine ER -