Modified Surgical Technique for Chiari Malformation

Ali Mahad Musallam Al-Mashani¹, Neeraj Salhotra¹, Azmat Ali¹, Aziz Haris², Rashid M Khan² and Naresh Kaul^2,

¹Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman

²Department of Anesthesia & ICU, Khoula Hospital, Muscat, Sultanate of Oman

Cite this paper

Ali Mahad Musallam Al-Mashani, Neeraj Salhotra, Azmat Ali, Aziz Haris, Rashid M Khan and Naresh Kaul. Modified Surgical Technique for Chiari Malformation. American Journal of Medical Case Reports. 2016; 4(6):193-197. doi: 10.12691/AJMCR-4-6-3

Abstract

Craniectomy with or without cervical laminectomy is a well-recognized treatment option for patients with symptomatic Chiari malformation. However, performing craniectomy removes the protection of the suboccipital cranial bone while laminectomy may limit cervical spine movement. We undertook a retrospective study of seventeen patients who underwent conventional craniectomy and cervical laminectomy or cranioplasty alone for correction of Chiari malformation. The objective was to present cinical outcome and complications when the Chiari malformation was corrected by conventional craniectomy/ laminectomy or craniotomy alone. In the craniotomy group with eleven patients, the inside of the suboccipital bone was resurfaced prior to replacing it thereby creating space for the cerebrospinal fluid to flow after adhesionolysis and careful resection/ shrinkage of subpial tonsils without performing laminectomy. Craniectomy and C1-C2 laminectomy was done in six patients as per standard procedure. At a variable followup period of 10 years after the surgery, we did not observe any difference in clinical outcome between the two groups. The resolution of syrinx was 54.5 % in the craniotomy group as compared to 66.7% in the craniectomy/ laminectomy group, while it persisted unchanged in one patient in each group. CSF leak was noted in 2 patients in each group. Reduction of symptoms like headache, neck pain or paresthesia showed reduction in intensity in all patients except paresthesia that persisted in 1 patient of the craniotomy group. The finding of this study suggests that performing craniotomy alone is as effective as craniectomy/ laminectomy in terms of outcome and relief of signs and symptoms of Chiari malformation.

Keywords

chiari malformation, craniotomy, craniectomy, cervical laminectomy

Copyright

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