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Child's Nervous System

, Volume 35, Issue 10, pp 1905–1909 | Cite as

Management: opinions from different centers—the Istituto Giannina Gaslini experience

  • Alberto Balestrino
  • Alessandro Consales
  • Marco Pavanello
  • Andrea Rossi
  • Paola Lanteri
  • Armando Cama
  • Gianluca PiatelliEmail author
Special Annual Issue

Abstract

Purpose

Describe presentation and management of Chiari type 1 malformation. We report our surgical case series proposing a decision making scheme for helping surgeons decide which surgical procedure to perform and when.

Methods

We retrospectively examined a series of surgically treated patients with Chiari type 1 malformation. Treatment of associated anomalies, surgical complications, and need for reintervention for insufficient decompression at first surgery are discussed.

Results

A total of 172 patients have been surgically treated for Chiari type 1 malformation at the Neurosurgery Unit of IRCCS Giannina Gaslini Children Hospital of Genoa, Italy, in a period between 2006 and 2017. The first treatment addressing Chiari type 1 malformation was bone and ligamentous decompression alone in 104 patients (65%), associated with dural delamination in 3 patients (1.9%) and associated with duraplasty with autologous graft in 53 patients (33.1%). Postoperative complications occurred in 5 patients (2.9%). Reintervention for insufficient decompression at follow-up was needed in 6 patients (3.5%).

Conclusions

Surgical decompression of the posterior cranial fossa (PCF) is indicated in symptomatic patients while asymptomatic patients must be followed in a wait and see fashion. Different types of surgical decompression of different invasiveness have been proposed from only bone and ligamentous decompression to coagulation of cerebellar tonsils. Intraoperative ultrasonography is a useful tool to define when a decompression is sufficient. We did not find correlation between the need for reintervention for insufficient decompression and different invasiveness of the techniques. We believe that this finding suggests that our proposed scheme leads to the best tailored treatment for the single patient.

Keywords

Chiari malformation Reintervention Surgical decompression 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Cama A, Tortori-Donati P, Piatelli GL, Fondelli MP, Andreussi L (1995) Chiari complex in children--neuroradiological diagnosis, neurosurgical treatment and proposal of a new classification (312 cases). Eur J Pediatr Surg 1:35–38.  https://doi.org/10.1055/s-2008-1066261 CrossRefGoogle Scholar
  2. 2.
    Liu W, Wu H, Aikebaier Y, Wulabieke M, Paerhati R, Yang X (2017) No significant difference between chiari malformation type 1.5 and type I. Clin Neurol Neurosurg 157:34–39.  https://doi.org/10.1016/j.clineuro.2017.03.024 CrossRefGoogle Scholar
  3. 3.
    Poretti A, Ashmawy R, Garzon-Muvdi T, Jallo GI, Huisman TA, Raybaud C (2016) Chiari type 1 deformity in children: pathogenetic, clinical, neuroimaging, and management aspects. Neuropediatrics 47(5):293–307.  https://doi.org/10.1055/s-0036-1584563 CrossRefPubMedGoogle Scholar
  4. 4.
    Aitken LA, Lindan CE, Sidney S, Gupta N, Barkovich AJ, Sorel M, Wu YW (2009) Chiari type I malformation in a pediatric population. Pediatr Neurol 40(6):449–454.  https://doi.org/10.1016/j.pediatrneurol.2009.01.003 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Raybaud C, Jallo GI (2018) Chiari 1 deformity in children: etiopathogenesis and radiologic diagnosis. Handb Clin Neurol 155:25–48.  https://doi.org/10.1016/B978-0-444-64189-2.00002-0 CrossRefPubMedGoogle Scholar
  6. 6.
    Massimi L, Peraio S, Peppucci E, Tamburrini G, Di Rocco C (2011) Section of the filum terminale: is it worthwhile in Chiari type I malformation? Neurol Sci 32(Suppl 3):S349–S351.  https://doi.org/10.1007/s10072-011-0691-4 CrossRefGoogle Scholar
  7. 7.
    Glenn C, Cheema AA, Safavi-Abbasi S, Gross NL, Martin MD, Mapstone TB (2015) Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations. J Clin Neurosci 22(11):1749–1752.  https://doi.org/10.1016/j.jocn.2015.05.023 CrossRefPubMedGoogle Scholar
  8. 8.
    Moncho D, Poca MA, Minoves T, Ferré A, Cañas V, Sahuquillo J (2017) Are evoked potentials clinically useful in the study of patients with Chiari malformation type 1? J Neurosurg 126(2):606–619.  https://doi.org/10.3171/2015.11.JNS151764 CrossRefPubMedGoogle Scholar
  9. 9.
    Giammattei L, Borsotti F, Parker F, Messerer M (2018) Chiari I malformation: surgical technique, indications and limits. Acta Neurochir 160(1):213–217.  https://doi.org/10.1007/s00701-017-3380-0 CrossRefPubMedGoogle Scholar
  10. 10.
    Lei ZW, Wu SQ, Zhang Z, Han Y, Wang JW, Li F, Shu K (2018) Clinical characteristics, imaging findings and surgical outcomes of Chiari malformation type I in pediatric and adult patients. Curr Med Sci 38(2):289–295.  https://doi.org/10.1007/s11596-018-1877-2 CrossRefPubMedGoogle Scholar
  11. 11.
    Sindou M, Chávez-Machuca J, Hashish H (2002) Cranio-cervical decompression for Chiari type I-malformation, adding extreme lateral foramen magnum opening and expansile duroplasty with arachnoid preservation. Technique and long-term functional results in 44 consecutive adult cases -- comparison with literature data. Acta Neurochir 144(10):1005–1019.  https://doi.org/10.1007/s00701-002-1004-8 CrossRefPubMedGoogle Scholar
  12. 12.
    Curone M, Valentini LG, Vetrano I, Beretta E, Furlanetto M, Chiapparini L, Erbetta A, Bussone G (2017) Chiari malformation type 1-related headache: the importance of a multidisciplinary study. Neurol Sci 38(Suppl 1):91–93.  https://doi.org/10.1007/s10072-017-2915-8 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alberto Balestrino
    • 1
    • 2
  • Alessandro Consales
    • 2
  • Marco Pavanello
    • 2
  • Andrea Rossi
    • 3
  • Paola Lanteri
    • 4
  • Armando Cama
    • 2
  • Gianluca Piatelli
    • 2
    Email author
  1. 1.Department of NeurosurgeryIRCCS Ospedale Policlinico San MartinoGenoaItaly
  2. 2.Division of Neurosurgery, Department of NeurosurgeryIRCCS Istituto Giannina Gaslini Children’s HospitalGenoaItaly
  3. 3.Department of NeuroradiologyIRCCS Istituto Giannina Gaslini Children’s HospitalGenoaItaly
  4. 4.Department of NeuropsychiatryIRCCS Istituto Giannina Gaslini Children’s HospitalGenoaItaly

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