Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients

Clinical article

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  • 1 Departments of Neurosurgery and
  • 2 Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
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Object

This study aims to show the relationship between clinical outcome in patients who underwent surgical decompression for Chiari malformation (CM) and postoperative imaging studies, with particular emphasis on the subarachnoid cisterns of the posterior fossa.

Methods

One hundred seventy-seven patients with CM, including 97 with syringomyelia, underwent posterior fossa decompressive surgery. Both the dura and arachnoid were opened in 150 of these patients, and 135 underwent reduction of the cerebellar tonsils. The patients' clinical signs and symptoms were evaluated at 2 time points after surgery. Their imaging studies were analyzed specifically for the size of the retrotonsillar and subtonsillar cisterns and the syringomyelic cavities. The authors evaluated the relationship between these imaging findings and clinical parameters.

Results

Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns, and enlargement of the cisterns also correlated with reduction in size of the syrinx cavities. Symptoms related to syringomyelia responded to reduction in size of the syrinx cavities.

Conclusions

Surgical decompression of the posterior fossa should aim to create relatively large subarachnoid cisterns and reduce the size of the syrinx cavity. Reduction of the cerebellar tonsils by surgical means, together with duraplasty, achieves this goal and thereby improves the clinical outcome for patients with CM. An incidental observation of the study is that obesity increases the likelihood of headache in patients with CM.

Abbreviations used in this paper:BMI = body mass index; CM = Chiari malformation; ePTFE = expanded polytetrafluoroethylene; UCLA = University of California, Los Angeles.

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Contributor Notes

Address correspondence to: Ulrich Batzdorf, M.D., David Geffen School of Medicine at UCLA, Department of Neurosurgery, 10833 Le Conte Avenue, Los Angeles, California 90095. email: ubatzdorf@mednet.ucla.edu.

Please include this information when citing this paper: published online November 23, 2012; DOI: 10.3171/2012.10.JNS12305.

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