Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis

Clinical article

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  • 1 Department of Neurosurgery, University of Texas Southwestern Medical Center;
  • 2 Department of Plastic and Craniofacial Surgery, Medical City Hospital; and
  • 3 Department of Pediatric Neurosurgery, Children's Medical Center, Dallas, Texas
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Object

The optimal management of Chiari malformations in the setting of craniosynostosis is not well established. In this report the authors describe their outcomes with the combined technique of simultaneous suboccipital decompression (SOD) during posterior cranial vault remodeling (PCVR).

Methods

A retrospective review was performed of all patients undergoing PCVR and simultaneous SOD. Demographic data, diagnosis, imaging studies, operative intervention, and clinical follow-up were evaluated.

Results

Thirty-four patients were identified as having undergone a simultaneous PCVR/SOD for Chiari malformation associated with craniosynostosis. Eighty-eight percent of these patients had syndromic, multisutural craniosynostosis, and the remaining patients had unilateral lambdoid craniosynostosis. There were no postoperative complications as a direct result from this combined procedure. Two patients required a subsequent direct approach for decompression of the Chiari malformation. The interval between these subsequent surgeries was 3 years and 19 months.

Conclusions

Chiari malformations are commonly associated with syndromic, complex craniosynostosis and isolated lambdoid craniosynostosis. In appropriately selected patients, a combined posterior cranial vault enlargement and SOD of the foramen magnum is associated with a low complication rate and appears to be an effective procedure.

Abbreviations used in this paper:PCVR = posterior cranial vault remodeling; SOD = suboccipital decompression.

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Contributor Notes

Address correspondence to: William Scott, M.D., 5323 Harry Hines Blvd., UTSW Department of Neurosurgery, Dallas, Texas 75390. email:william_w_scott@hotmail.com.

Please include this information when citing this paper: published online May 24, 2013; DOI: 10.3171/2013.4.PEDS12463.

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