Chiari malformations in adults: A single center surgical experience with special emphasis on the kinetics of clinical improvement - 07/06/19
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Abstract |
Background |
The Chiari malformation type I (CM-I) is the most commonly found type in adults. The efforts to further improve the treatment offered for these malformations are hampered by the existence of controversial methods and the absence of a uniform scoring system to evaluate clinical outcomes.
Objectives |
The goal of our study is to analyze the clinical and radiological data concerning patients operated for CM and to expose surgical techniques.
Patients and treatment |
This is a retrospective study concerning patients of more than 16 years of age, operated on (from 2000 to 2016) in our institution. These patients underwent bony decompression of the cervico-occipital junction, with a duraplasty enlargement. Clinical and radiological follow-up was assessed sequentially.
Results |
The mean age of patients included in this study was 39. Headaches (n=19) and sensory disturbances (n=17) were the most common presenting complaints. Furthermore, syringomyelia symptoms were present in 34.5% of the cases (n=10). Twenty-three patients displayed a Chiari malformation of type I (79.3%), and six patients were classified as Chiari malformation type I.5 (20.7%). A syringomyelia was present in 58.6% of the cases (n=17). The postoperative complications that were encountered were: one case of pseudo-meningocele, two cases of cerebrospinal fluid leakage, two cases of meningitis, and one case of delayed wound healing. The mean follow-up period was 18 months, which showed beneficial outcomes in 82.8% of the cases (20.7% cured, and 62.1% improved) and an unfavorable outcome in 17.2% of the cases (13.8% stable patients and 3.4% worsened outcomes). Syringomyelia symptoms were improved in 60% of the patients. Among the patients who presented without a syrinx, 82.3% had good outcomes; and those who presented with a syrinx, 83.4% had good outcomes. Symptoms improved for 69% of patients within 3 months.
Conclusion |
An optimal craniocervical osteo-dural decompression plus duraplasty offered early and sustainable good clinical results in symptomatic CM-I and CM-I.5 patients.
Le texte complet de cet article est disponible en PDF.Keywords : Chiari malformation, Occipito-cervical decompression - Syringomyelia
Plan
Vol 65 - N° 2-3
P. 69-74 - avril 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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