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Classification of Symptomatic Chiari I Malformation to Guide Surgical Strategy

Published online by Cambridge University Press:  02 December 2014

Mohammed F. Shamji ,
Enrique C. G. Ventureyra ,
Benedicto Baronia ,
Munyao Nzau  and
Michael Vassilyadi
Mohammed F. Shamji
Affiliation:
Division of Neurosurgery, The Ottawa Hospital
Enrique C. G. Ventureyra*
Affiliation:
Division of Neurosurgery, The Ottawa Hospital Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Benedicto Baronia
Affiliation:
Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Munyao Nzau
Affiliation:
Division of Neurosurgery, The Ottawa Hospital Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Michael Vassilyadi
Affiliation:
Division of Neurosurgery, The Ottawa Hospital Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
*
Division of Neurosurgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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Abstract

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Background:

Treatment options for Chiari I malformations include posterior fossa decompression (PFD) with additional techniques including laminectomy, intradural exploration, and duraplasty. Neuroimaging findings of cisterna magna volume, syringomyelia, and intraoperative ultrasonography may tailor surgical intervention.

Methods:

We developed an algorithm classifying symptomatic Chiari I patients into three groups to define minimum operation. Without syringomyelia, the presence of cisterna magna defined Group A and the absence defined Group B. Patients with syrinx formed Group C. Mild structural pathology (Group A) or adequate space following PFD (Group B, normal intraoperative ultrasound (IOUS)) should be treated by PFD alone. Conversely, presence of syringomyelia (Group C) or inadequate space following PFD (Group B, abnormal IOUS) should additionally have duraplasty. We applied this algorithm to patients treated at a single institution over 16 years.

Results:

Twenty-four symptomatic Chiari I malformation patients were divided into three groups that did not differ by age, gender, or extent of tonsillar ectopia. All patients treated by this algorithm experienced clinical and radiographic improvement. This included eight Group B patients who underwent PFD only (n=6) or additional duraplasty (n=2) decided by IOUS.

Conclusion:

Treatment of symptomatic Chiari I malformation may have inadequate outcome with conservative strategy or complications with aggressive strategy. This algorithm utilizes preoperative neuroimaging and intraoperative ultrasound to tailor intervention, with excellent clinical outcome and radiographic syrinx resolution on application to 24 patients. Further validation requires prospective multicenter evaluation with larger patient population.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 4 , July 2010 , pp. 482 - 487
Copyright
Copyright © The Canadian Journal of Neurological 2010

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