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Minimally invasive foramen magnum decompression using tubular retractors (MIFT) for Chiari I malformations

  • How I Do it - Spine - Other
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Acta Neurochirurgica Aims and scope

Abstract

Background

Chiari malformation type 1 has been traditionally treated with foramen magnum decompression and C1 arch excision with or without duroplasty depending on the surgeon’s preference. Each of the various surgical modifications has its advantages and disadvantages.

Methods

We describe a minimally invasive tubular retractor-based approach to achieve bony decompression in these cases. We have had good results comparable to the open approach.

Conclusions

Strict orientation to the midline using soft tissue landmarks in between the muscles and bony landmarks in the deeper planes is important to achieve good surgical results. Operative time decreases with expertise and is comparable to the open technique. Minimal blood loss and decreased hospital stay and an excellent cosmetic scar make this procedure more appealing.

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Data Availability

The data used to support the findings of this study are available within the article. Any further information regarding the article are available from the corresponding author upon reasonable request.

References

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, II Floor, Faculty Block, Hosur Road, Bangalore, 560029, India

    Gaurav Tyagi, Alok Mohan Uppar, Nupur Pruthi & Dhaval Shukla

Authors
  1. Gaurav Tyagi
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  2. Alok Mohan Uppar
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  3. Nupur Pruthi
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  4. Dhaval Shukla
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Corresponding author

Correspondence to Alok Mohan Uppar.

Ethics declarations

Ethics approval

All procedures performed in the current study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Written informed consent was taken from the patient and family before the procedure, including the use of anonymized patient data (clinical and radiological) for scientific research and publication.

Conflict of interest

The authors declare no competing interests.

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Key points summary

1. Mild flexion of the head while positioning helps in opening the space between the foramen magnum and the C1 arch.

2. Perpendicularly placed bored needles are important to plan incisions using lateral fluoroscopy.

3. Extremely important to stay in the midline to avoid false tracking and improper bony work.

4. Midline ridge on the C1 arch and occipital bone act as good landmarks to orient the surgeon toward the midline.

5. An incision with a knife and midline soft tissue dissection with cautery need to be done with caution to avoid puncturing the dura.

6. Lateral tissue expanding retractors can be used by novice surgeons to get a good overview in the beginning cases.

7. Toggling the expandable retractors craniocaudally helps in gaining more length of tissue exposure with a small skin incision.

8. All dural injuries must be taken seriously and prompt closure using muscle/fat graft must be done.

9. Continuous running fascial suturing is of utmost importance, especially in cases where there is a dural injury.

10. Subcuticular suturing provides the best cosmetic results than interrupted sutures.

This article is part of the Topical Collection on Spine—Other

Supplementary Information

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Tyagi, G., Uppar, A.M., Pruthi, N. et al. Minimally invasive foramen magnum decompression using tubular retractors (MIFT) for Chiari I malformations. Acta Neurochir 165, 767–770 (2023). https://doi.org/10.1007/s00701-023-05490-0

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  • DOI: https://doi.org/10.1007/s00701-023-05490-0

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