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Tonsillectomy with modified reconstruction of the cisterna magna with and without craniectomy for the treatment of adult Chiari malformation type I with syringomyelia.
Acta Neurochir (Wien). 2020 07; 162(7):1585-1595.AN

Abstract

BACKGROUND

In light of the controversies regarding the surgical treatment of adult Chiari malformation type I (CM-I) with syringomyelia, a retrospective study was conducted to evaluate the safety and efficacy of tonsillectomy followed by modified reconstruction of the cisterna magna with or without craniectomy.

METHODS

Between 2008 and 2017, 78 adult CM-I patients (36 males and 42 females, mean age 40.6 years old) with syringomyelia were treated with posterior fossa decompression (PFD) with tonsillectomy and modified reconstruction of the cisterna magna. Patients were divided into two study groups: group A (n = 40) underwent cranioplasty with replacement of the bone flap; group B (n = 38) underwent suboccipital craniectomy. Neurological outcomes were evaluated by traditional physician assessment (improved, unchanged, and worsened) and the Chicago Chiari Outcome Scale (CCOS). Syringomyelia outcomes were assessed radiologically.

RESULTS

The procedure was successfully performed in all patients, and restoration of normal cerebrospinal fluid (CSF) flow was confirmed by intraoperative ultrasonography. The median postoperative follow-up was 20.3 months (range 18-60 months). Clinical improvement was evident in 66 (84.6%) patients, with no significant differences between the two groups (85.0% vs. 84.2%, P = 0.897). According to the CCOS, 36 patients (90.0%) in group A were labeled as "good" outcome, compared with that of 34 (86.8%) in group B (P = 0.734). Improvement of syringomyelia was also comparable between the groups, which was observed in 35 (87.5%) vs. 33 (86.8%) patients (P = 0.887). The postoperative overall (7.5% vs. 23.7%, P = 0.048) and CSF-related (2.5% vs. 18.4%, P = 0.027) complication rates were significantly lower in group A than group B.

CONCLUSIONS

Tonsillectomy with modified reconstruction of the cisterna magna without craniectomy seems to be a safe and effective surgical option to treat adult CM-I patients with syringomyelia, though future well-powered prospective randomized studies are warranted to validate these findings.

Authors+Show Affiliations

Department of Neurosurgery, Xi'an International Medical Center, No.1 Xitai Road, Xi'an, 710100, Shaanxi Province, China. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Xi'an International Medical Center, No.1 Xitai Road, Xi'an, 710100, Shaanxi Province, China. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Xi'an International Medical Center, No.1 Xitai Road, Xi'an, 710100, Shaanxi Province, China. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Xi'an International Medical Center, No.1 Xitai Road, Xi'an, 710100, Shaanxi Province, China. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Duke University Medical Center, Durham, NC, 27710, USA.Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.Department of Neurosurgery, Xi'an International Medical Center, No.1 Xitai Road, Xi'an, 710100, Shaanxi Province, China. he-shiming@163.com. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China. he-shiming@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31897729

Citation

Liu, Bolin, et al. "Tonsillectomy With Modified Reconstruction of the Cisterna Magna With and Without Craniectomy for the Treatment of Adult Chiari Malformation Type I With Syringomyelia." Acta Neurochirurgica, vol. 162, no. 7, 2020, pp. 1585-1595.
Liu B, Wang Y, Liu S, et al. Tonsillectomy with modified reconstruction of the cisterna magna with and without craniectomy for the treatment of adult Chiari malformation type I with syringomyelia. Acta Neurochir (Wien). 2020;162(7):1585-1595.
Liu, B., Wang, Y., Liu, S., Zhang, Y., Lu, D., Chen, L., Zheng, T., Zhao, T., Zhao, L., Sankey, E. W., Gao, G., Qu, Y., & He, S. (2020). Tonsillectomy with modified reconstruction of the cisterna magna with and without craniectomy for the treatment of adult Chiari malformation type I with syringomyelia. Acta Neurochirurgica, 162(7), 1585-1595. https://doi.org/10.1007/s00701-019-04177-9
Liu B, et al. Tonsillectomy With Modified Reconstruction of the Cisterna Magna With and Without Craniectomy for the Treatment of Adult Chiari Malformation Type I With Syringomyelia. Acta Neurochir (Wien). 2020;162(7):1585-1595. PubMed PMID: 31897729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tonsillectomy with modified reconstruction of the cisterna magna with and without craniectomy for the treatment of adult Chiari malformation type I with syringomyelia. AU - Liu,Bolin, AU - Wang,Yuan, AU - Liu,Shujuan, AU - Zhang,Yufu, AU - Lu,Dan, AU - Chen,Lei, AU - Zheng,Tao, AU - Zhao,Tianzhi, AU - Zhao,Lanfu, AU - Sankey,Eric W, AU - Gao,Guodong, AU - Qu,Yan, AU - He,Shiming, Y1 - 2020/01/02/ PY - 2019/08/18/received PY - 2019/12/12/accepted PY - 2020/1/4/pubmed PY - 2021/1/7/medline PY - 2020/1/4/entrez KW - Cerebellar tonsil KW - Chiari malformation type I KW - Cranioplasty KW - Decompression KW - Syringomyelia KW - Ultrasonography SP - 1585 EP - 1595 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 162 IS - 7 N2 - BACKGROUND: In light of the controversies regarding the surgical treatment of adult Chiari malformation type I (CM-I) with syringomyelia, a retrospective study was conducted to evaluate the safety and efficacy of tonsillectomy followed by modified reconstruction of the cisterna magna with or without craniectomy. METHODS: Between 2008 and 2017, 78 adult CM-I patients (36 males and 42 females, mean age 40.6 years old) with syringomyelia were treated with posterior fossa decompression (PFD) with tonsillectomy and modified reconstruction of the cisterna magna. Patients were divided into two study groups: group A (n = 40) underwent cranioplasty with replacement of the bone flap; group B (n = 38) underwent suboccipital craniectomy. Neurological outcomes were evaluated by traditional physician assessment (improved, unchanged, and worsened) and the Chicago Chiari Outcome Scale (CCOS). Syringomyelia outcomes were assessed radiologically. RESULTS: The procedure was successfully performed in all patients, and restoration of normal cerebrospinal fluid (CSF) flow was confirmed by intraoperative ultrasonography. The median postoperative follow-up was 20.3 months (range 18-60 months). Clinical improvement was evident in 66 (84.6%) patients, with no significant differences between the two groups (85.0% vs. 84.2%, P = 0.897). According to the CCOS, 36 patients (90.0%) in group A were labeled as "good" outcome, compared with that of 34 (86.8%) in group B (P = 0.734). Improvement of syringomyelia was also comparable between the groups, which was observed in 35 (87.5%) vs. 33 (86.8%) patients (P = 0.887). The postoperative overall (7.5% vs. 23.7%, P = 0.048) and CSF-related (2.5% vs. 18.4%, P = 0.027) complication rates were significantly lower in group A than group B. CONCLUSIONS: Tonsillectomy with modified reconstruction of the cisterna magna without craniectomy seems to be a safe and effective surgical option to treat adult CM-I patients with syringomyelia, though future well-powered prospective randomized studies are warranted to validate these findings. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/31897729/Tonsillectomy_with_modified_reconstruction_of_the_cisterna_magna_with_and_without_craniectomy_for_the_treatment_of_adult_Chiari_malformation_type_I_with_syringomyelia_ L2 - https://dx.doi.org/10.1007/s00701-019-04177-9 DB - PRIME DP - Unbound Medicine ER -