Chiari malformations in adults: A single center surgical experience with special emphasis on the kinetics of clinical improvement.
Chiari malformation
Occipito-cervical decompression - Syringomyelia
Journal
Neuro-Chirurgie
ISSN: 1773-0619
Titre abrégé: Neurochirurgie
Pays: France
ID NLM: 0401057
Informations de publication
Date de publication:
Historique:
received:
21
10
2017
revised:
26
08
2018
accepted:
06
10
2018
pubmed:
13
2
2019
medline:
23
11
2019
entrez:
13
2
2019
Statut:
ppublish
Résumé
The Chiari malformation type I (CM-I) is the most commonly found type in adults. The efforts to further improve the treatment offered for these malformations are hampered by the existence of controversial methods and the absence of a uniform scoring system to evaluate clinical outcomes. The goal of our study is to analyze the clinical and radiological data concerning patients operated for CM and to expose surgical techniques. This is a retrospective study concerning patients of more than 16 years of age, operated on (from 2000 to 2016) in our institution. These patients underwent bony decompression of the cervico-occipital junction, with a duraplasty enlargement. Clinical and radiological follow-up was assessed sequentially. The mean age of patients included in this study was 39. Headaches (n=19) and sensory disturbances (n=17) were the most common presenting complaints. Furthermore, syringomyelia symptoms were present in 34.5% of the cases (n=10). Twenty-three patients displayed a Chiari malformation of type I (79.3%), and six patients were classified as Chiari malformation type I.5 (20.7%). A syringomyelia was present in 58.6% of the cases (n=17). The postoperative complications that were encountered were: one case of pseudo-meningocele, two cases of cerebrospinal fluid leakage, two cases of meningitis, and one case of delayed wound healing. The mean follow-up period was 18 months, which showed beneficial outcomes in 82.8% of the cases (20.7% cured, and 62.1% improved) and an unfavorable outcome in 17.2% of the cases (13.8% stable patients and 3.4% worsened outcomes). Syringomyelia symptoms were improved in 60% of the patients. Among the patients who presented without a syrinx, 82.3% had good outcomes; and those who presented with a syrinx, 83.4% had good outcomes. Symptoms improved for 69% of patients within 3 months. An optimal craniocervical osteo-dural decompression plus duraplasty offered early and sustainable good clinical results in symptomatic CM-I and CM-I.5 patients.
Sections du résumé
BACKGROUND
BACKGROUND
The Chiari malformation type I (CM-I) is the most commonly found type in adults. The efforts to further improve the treatment offered for these malformations are hampered by the existence of controversial methods and the absence of a uniform scoring system to evaluate clinical outcomes.
OBJECTIVES
OBJECTIVE
The goal of our study is to analyze the clinical and radiological data concerning patients operated for CM and to expose surgical techniques.
PATIENTS AND TREATMENT
METHODS
This is a retrospective study concerning patients of more than 16 years of age, operated on (from 2000 to 2016) in our institution. These patients underwent bony decompression of the cervico-occipital junction, with a duraplasty enlargement. Clinical and radiological follow-up was assessed sequentially.
RESULTS
RESULTS
The mean age of patients included in this study was 39. Headaches (n=19) and sensory disturbances (n=17) were the most common presenting complaints. Furthermore, syringomyelia symptoms were present in 34.5% of the cases (n=10). Twenty-three patients displayed a Chiari malformation of type I (79.3%), and six patients were classified as Chiari malformation type I.5 (20.7%). A syringomyelia was present in 58.6% of the cases (n=17). The postoperative complications that were encountered were: one case of pseudo-meningocele, two cases of cerebrospinal fluid leakage, two cases of meningitis, and one case of delayed wound healing. The mean follow-up period was 18 months, which showed beneficial outcomes in 82.8% of the cases (20.7% cured, and 62.1% improved) and an unfavorable outcome in 17.2% of the cases (13.8% stable patients and 3.4% worsened outcomes). Syringomyelia symptoms were improved in 60% of the patients. Among the patients who presented without a syrinx, 82.3% had good outcomes; and those who presented with a syrinx, 83.4% had good outcomes. Symptoms improved for 69% of patients within 3 months.
CONCLUSION
CONCLUSIONS
An optimal craniocervical osteo-dural decompression plus duraplasty offered early and sustainable good clinical results in symptomatic CM-I and CM-I.5 patients.
Identifiants
pubmed: 30744958
pii: S0028-3770(19)30003-7
doi: 10.1016/j.neuchi.2018.10.010
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
69-74Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.