Chiari I malformation with syringomyelia

Evaluation of surgical therapy by magnetic resonance imaging

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✓ Five patients with a Chiari I-syringomyelia complex of adult onset were evaluated by magnetic resonance (MR) imaging. All patients underwent suboccipital craniotomy with upper cervical (C-1 and part of C-2) laminectomy, arachnoid retraction, and duraplasty. Postoperative MR studies of four patients disclosed collapse of the syringomyelic cavity, even when the cavity extended into the thoracic region. This appeared to be a progressive process taking place over several weeks. Operative complications are noted and physiological implications are discussed.

Article Information

Address reprint requests to: Ulrich Batzdorf, M.D., Division of Neurosurgery, School of Medicine, UCLA Medical Center, Los Angeles, California 90024.

© AANS, except where prohibited by US copyright law.

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Figures

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    Artist's operative drawings. a: Dissection of the arachnoid away from the cerebellar tonsils. Inset: Closure of the suboccipital wound, showing placement of a dural graft and suture which incorporates the free edge of the retracted arachnoid. b: Separation of the cerebellar tonsils and direction of arachnoid suture in cases where the arachnoid is adherent to the tonsils. c: Placement of a tube from the fourth ventricle to the cervical subarachnoid space in cases where the arachnoid is adherent and the tonsils cannot be widely separated.

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    Case 3. Left: Preoperative cervical magnetic resonance image (TE 38 msec) showing a septated cervical syrinx and portions of a presumed communication with the fourth ventricle. Right: Image obtained 6 weeks postoperatively (TE 39 msec) showing collapse of the syrinx following suboccipital and C-1 decompression with duraplasty as described.

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    Case 5. Magnetic resonance images (TE 28 msec) of the cervical region preoperatively (a) and 10 days (b) and 4½ weeks (c) after suboccipital decompression with duraplasty. Progressive collapse of the cervical syrinx over the 4½ week period is evident.

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