| Classification of symptomatic Chiari I malformation to guide surgical strategy. | |
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MedLine Citation:
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PMID: 20724256 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Treatment options for Chiari I malformations include posterior fossa decompression (PFD) with additional techniques including laminectomy, intradural exploration, and duraplasty. Neuroimaging findings of cisterna magna volume, syringomyelia, and intraoperative ultrasonography may tailor surgical intervention. METHODS: We developed an algorithm classifying symptomatic Chiari I patients into three groups to define minimum operation. Without syringomyelia, the presence of cisterna magna defined Group A and the absence defined Group B. Patients with syrinx formed Group C. Mild structural pathology (Group A) or adequate space following PFD (Group B, normal intraoperative ultrasound (IOUS)) should be treated by PFD alone. Conversely, presence of syringomyelia (Group C) or inadequate space following PFD (Group B, abnormal IOUS) should additionally have duraplasty. We applied this algorithm to patients treated at a single institution over 16 years. RESULTS: Twenty-four symptomatic Chiari I malformation patients were divided into three groups that did not differ by age, gender, or extent of tonsillar ectopia. All patients treated by this algorithm experienced clinical and radiographic improvement. This included eight Group B patients who underwent PFD only (n=6) or additional duraplasty (n=2) decided by IOUS. CONCLUSION: Treatment of symptomatic Chiari I malformation may have inadequate outcome with conservative strategy or complications with aggressive strategy. This algorithm utilizes preoperative neuroimaging and intraoperative ultrasound to tailor intervention, with excellent clinical outcome and radiographic syrinx resolution on application to 24 patients. Further validation requires prospective multicenter evaluation with larger patient population. |
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Authors:
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Mohammed F Shamji; Enrique C G Ventureyra; Benedicto Baronia; Munyao Nzau; Michael Vassilyadi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques Volume: 37 ISSN: 0317-1671 ISO Abbreviation: Can J Neurol Sci Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-08-20 Completed Date: 2010-09-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0415227 Medline TA: Can J Neurol Sci Country: Canada |
Other Details:
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Languages: eng Pagination: 482-7 Citation Subset: IM |
Affiliation:
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Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Arnold-Chiari Malformation / classification*, complications, diagnosis, surgery* Child Child, Preschool Cisterna Magna / surgery Decompression, Surgical / methods* Dura Mater / surgery*, ultrasonography Female Humans Infant Intraoperative Period Laminectomy / methods Magnetic Resonance Imaging / methods Male Reconstructive Surgical Procedures / methods Retrospective Studies Syringomyelia / etiology, surgery Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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