Acta Neurochir (Wien)
1996;
The surgical treatment of Chiari I malformation. Klekamp
J, Batzdorf U, Samii M, Bothe HW
Medical School of Hannover, Neurosurgical Clinic,
Nordstadt Hospital Hannover, Federal Republic of Germany.
A retrospective study was undertaken on 133 patients with
a Chiari I malformation treated within the last 16 years at the Departments of
Neurosurgery at the Nordstadt Hospital Hannover, Germany, and the University of
California, Los Angeles, U.S.A. Ninety-seven patients presented with symptoms
related to accompanying syringomyelia and 4 with associated syringobulbia. They
underwent 149 surgical procedures and were followed for a mean of 39 +/- 52
months. A decompression at the foramen magnum was performed in 124 patients,
while 22 of those with syringomyelia were treated by shunting (7
syringosubarachnoid shunts, 15 syringoperitoneal or -pleural shunts), and 3 by
ventriculoperitoneal shunts for hydrocephalus. Except for ventriculoperitoneal
shunting, at least a short-term decrease in size of an associated syrinx was
observed for all procedures in the majority of cases. However, no long-term
benefit was observed for syrinx shunting operations. The best clinical long-term
results were obtained with decompression of the foramen magnum in patients with
(86% free of a clinical recurrence) and without syringomyelia (77%
free of a clinical recurrence). We advise against syrinx shunting, a large
craniectomy, and obex plugging which are associated with higher recurrence
rates. Instead, surgery should consist of a small craniectomy, opening of the
dura, archnoid dissection to establish normal cerebrospinal fluid (CSF) outflow
from the 4th ventricle, and a fascia lata dural graft.
PMID: 8869706, UI: 97023346
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