Document Detail


Classification of symptomatic Chiari I malformation to guide surgical strategy.
MedLine Citation:
PMID:  20724256     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Mohammed F Shamji; Enrique C G Ventureyra; Benedicto Baronia; Munyao Nzau; Michael Vassilyadi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2010-08-20     Completed Date:  2010-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0415227     Medline TA:  Can J Neurol Sci     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  482-7     Citation Subset:  IM    
Affiliation:
Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
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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