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Surgical Treatment in Symptomatic Chiari Malformation Type I: A Series of 25 Adult Patients Treated with Cerebellar Tonsil Shrinkage

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New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

Background: The variety of symptoms and radiological findings in patients with Chiari malformation type I makes both the indication for surgery and the technical modality controversial. We report our 5-year experience, describing our technique and critically evaluating the clinical results.

Methods: Between 2012 and 2016, 25 patients (15 female and 10 male; mean age 39.2 years) underwent posterior fossa decompression for Chiari malformation type I. Their clinical complaints included headache, nuchalgia, upper limb weakness or numbness, instability, dizziness and diplopia. Syringomyelia was present in 12 patients (48%). Suboccipital craniectomy was completed in all cases with C1 laminectomy and shrinkage of the cerebellar tonsils by bipolar coagulation; duraplasty was performed with a suturable dura substitute.

Results: Gratifying results were observed in our series. Symptoms and signs were resolved in 52% of patients, and 20% of patients had an improvement in their preoperative deficits. The symptoms of six patients (24%) were essentially unchanged, and one patient (4%) deteriorated despite undergoing surgery. Generally, patients with syringomyelia on magnetic resonance imaging (MRI) showed less symptomatic improvement after surgery. The syrinx disappeared in seven of 12 patients, and complications occurred in three patients (12%).

Conclusion: Cerebellar tonsil reduction and restoration of cerebrospinal fluid (CSF) circulation provided clinical improvement and a stable reduction in the syrinx size in the vast majority of treated patients, with a low rate of complications.

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Authors and Affiliations

  1. Division of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy

    Alessandro Villa & Natale Francaviglia

  2. Division of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy

    Alessia Imperato

  3. Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Palermo, Italy

    Rosario Maugeri & Domenico Gerardo Iacopino

  4. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

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  1. Alessandro Villa
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  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

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Villa, A., Imperato, A., Maugeri, R., Visocchi, M., Iacopino, D.G., Francaviglia, N. (2019). Surgical Treatment in Symptomatic Chiari Malformation Type I: A Series of 25 Adult Patients Treated with Cerebellar Tonsil Shrinkage. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_18

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_18

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