Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Surgical Outcome of Adult Idiopathic Chiari Malformation Type 1

  • Yuh, Woon Tak (Department of Neurosurgery, Seoul National University Hospital) ;
  • Kim, Chi Heon (Department of Neurosurgery, Seoul National University Hospital) ;
  • Chung, Chun Kee (Department of Neurosurgery, Seoul National University Hospital) ;
  • Kim, Hyun-Jib (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Jahng, Tae-Ahn (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Park, Sung Bae (Department of Neurosurgery, Seoul National University College of Medicine)
  • Received : 2016.04.04
  • Accepted : 2016.06.21
  • Published : 2016.09.01
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Abstract

Objective : The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. Methods : Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18-63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (${\geq}50%$ decrease in the diameter of the syrinx) were investigated. The follow-up period was $72.7{\pm}55.6$ months. Results : Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. Conclusion : Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.

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References

  1. Alfieri A, Pinna G : Long-term results after posterior fossa decompression in syringomyelia with adult Chiari Type I malformation. J Neurosurg Spine 17 : 381-387, 2012 https://doi.org/10.3171/2012.7.SPINE12272
  2. Bao C, Yang F, Liu L, Wang B, Li D, Gu Y, et al. : Surgical treatment of Chiari I malformation complicated with syringomyelia. Exp Ther Med 5 : 333-337, 2013 https://doi.org/10.3892/etm.2012.784
  3. Batzdorf U, McArthur DL, Bentson JR : Surgical treatment of Chiari malformation with and without syringomyelia : experience with 177 adult patients. J Neurosurg 118 : 232-242, 2013 https://doi.org/10.3171/2012.10.JNS12305
  4. Greitz D : Unraveling the riddle of syringomyelia. Neurosurg Rev 29 : 251-263; discussion 264, 2006 https://doi.org/10.1007/s10143-006-0029-5
  5. Heiss JD, Suffredini G, Bakhtian KD, Sarntinoranont M, Oldfield EH : Normalization of hindbrain morphology after decompression of Chiari malformation Type I. J Neurosurg 117 : 942-946, 2012 https://doi.org/10.3171/2012.8.JNS111476
  6. Kalb S, Perez-Orribo L, Mahan M, Theodore N, Nakaji P, Bristol RE : Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation. J Clin Neurosci 19 : 1268-1272, 2012 https://doi.org/10.1016/j.jocn.2012.01.025
  7. Kim IK, Wang KC, Kim IO, Cho BK : Chiari 1.5 malformation : an advanced form of Chiari I malformation. J Korean Neurosurg Soc 48 : 375-379, 2010 https://doi.org/10.3340/jkns.2010.48.4.375
  8. Kim J, Kim CH, Jahng TA, Chung CK : Clinical course of incidental syringomyelia without predisposing pathologies. J Clin Neurosci 19 : 665-668, 2012 https://doi.org/10.1016/j.jocn.2011.07.050
  9. Klekamp J : Neurological deterioration after foramen magnum decompression for Chiari malformation type I : old or new pathology? J Neurosurg Pediatr 10 : 538-547, 2012 https://doi.org/10.3171/2012.9.PEDS12110
  10. Klekamp J : Surgical treatment of Chiari I malformation--analysis of intraoperative findings, complications, and outcome for 371 foramen magnum decompressions. Neurosurgery 71 : 365-380; discussion 380, 2012 https://doi.org/10.1227/NEU.0b013e31825c3426
  11. Klekamp J : The pathophysiology of syringomyelia - historical overview and current concept. Acta Neurochir (Wien) 144 : 649-664, 2002 https://doi.org/10.1007/s00701-002-0944-3
  12. Koyanagi I, Houkin K : Pathogenesis of syringomyelia associated with Chiari type 1 malformation : review of evidences and proposal of a new hypothesis. Neurosurg Rev 33 : 271-284; discussion 284-285, 2010 https://doi.org/10.1007/s10143-010-0266-5
  13. Lee JH, Chung CK, Kim HJ : Cerebral dissection from syringomyelia demonstrated using cine magnetic resonance imaging. Case report. J Neurosurg 94 : 318-321, 2001 https://doi.org/10.3171/jns.2001.94.2.0318
  14. Lee JH, Chung CK, Kim HJ : Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation. Spinal Cord 40 : 501-506, 2002 https://doi.org/10.1038/sj.sc.3101322
  15. Logue V, Edwards MR : Syringomyelia and its surgical treatment--an analysis of 75 patients. J Neurol Neurosurg Psychiatry 44 : 273-284, 1981 https://doi.org/10.1136/jnnp.44.4.273
  16. Loukas M, Noordeh N, Shoja MM, Pugh J, Oakes WJ, Tubbs RS : Hans Chiari (1851-1916). Childs Nerv Syst 24 : 407-409, 2008 https://doi.org/10.1007/s00381-007-0535-y
  17. McCormick PC, Torres R, Post KD, Stein BM : Intramedullary ependymoma of the spinal cord. J Neurosurg 72 : 523-532, 1990 https://doi.org/10.3171/jns.1990.72.4.0523
  18. Shamji MF, Ventureyra EC, Baronia B, Nzau M, Vassilyadi M : Classification of symptomatic Chiari I malformation to guide surgical strategy. Can J Neurol Sci 37 : 482-487, 2010 https://doi.org/10.1017/S0317167100010507
  19. Sohn S, Chung CK, Kim CH : Is closed-suction drainage necessary after intradural primary spinal cord tumor surgery? Eur Spine J 22 : 577-583, 2013 https://doi.org/10.1007/s00586-012-2504-8
  20. Song SW, Chung CK : Acquired Chiari malformation. J Korean Neurosurg Soc 40 : 38-39, 2006
  21. Tubbs RS, Beckman J, Naftel RP, Chern JJ, Wellons JC 3rd, Rozzelle CJ, et al. : Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J Neurosurg Pediatr 7 : 248-256, 2011 https://doi.org/10.3171/2010.12.PEDS10379
  22. Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes WJ : A critical analysis of the Chiari 1.5 malformation. J Neurosurg 101 (2 Suppl) : 179-183, 2004 https://doi.org/10.3171/jns.2004.101.2.0179
  23. Tubbs RS, McGirt MJ, Oakes WJ : Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg 99 : 291-296, 2003 https://doi.org/10.3171/jns.2003.99.2.0291

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