Background: Foramen magnum decompression is widely accepted as the treatment of choice for Chiari I malformation. However, important surgical details of the procedure are controversial.
Objective: This study analyzes 371 decompressions focusing on intraoperative findings, analysis of complications, and long-term outcomes.
Methods: Among 644 patients between 1985 and 2010, 359 patients underwent 371 decompressions. Surgery for symptomatic patients consisted of suboccipital craniectomy, C1 laminectomy, arachnoid dissection, and duraplasty. Short-term results were determined after 3 months; long-term outcomes were evaluated with Kaplan-Meier statistics.
Results: The mean age was 40 ± 16 years; mean follow-up was 49 ± 56 months; 75.8% demonstrated syringomyelia. The complication rate was 21.8% with permanent surgical morbidity of 3.2% and surgical mortality of 1.3%. Of the patients, 73.6% reported improvement after 3 months; 21% were unchanged. Overall, 14.3% demonstrated a neurological deterioration within 5 years and 15.4% within 10 years. The severity of neurological symptoms correlated with the grade of arachnoid pathology. Outcome data correlated with the number of previous decompressions, severity of arachnoid pathology, handling of the arachnoid, type of duraplasty, and surgical experience. First-time decompressions with arachnoid dissection and an alloplastic duraplasty resulted in surgical morbidity for 2.0%, a 0.9% mortality rate, postoperative improvement after 3 months for 82%, and neurological recurrence rates of 7% after 5 years and 8.7% after 10 years.
Conclusion: Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results. Decompressions with arachnoid dissection and an alloplastic duraplasty performed by surgeons experienced with this pathology offer a favorable long-term prognosis.
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http://dx.doi.org/10.1227/NEU.0b013e31825c3426 | DOI Listing |
Oper Neurosurg (Hagerstown)
January 2025
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Background And Importance: Fusiform middle cerebral artery (MCA) bifurcation aneurysms can be challenging to treat with standard endovascular or microsurgical techniques. The in situ side-to-side bypass technique represents an elegant revascularization option for these aneurysms when trapping becomes necessary.
Clinical Presentation: A man in his 50s presented for evaluation of an incidentally found fusiform, 10 mm, right MCA bifurcation aneurysm with involvement of both the inferior and superior M2 trunks.
J Neurol Surg Rep
October 2024
Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Selective dorsal rhizotomy (SDR) is a surgical technique to treat spasticity, mainly in children with spastic cerebral palsy (CP). In this report, a unique case of a late arachnoid cyst, causing radiating pain in the left leg, is presented. This is relevant to clinicians managing the long-term follow-up of patients who underwent selective dorsal rhizotomy (SDR).
View Article and Find Full Text PDFFront Neuroanat
November 2024
Department of Intensive Care Unit, Liuzhou People's Hospital, Liuzhou, Guangxi, China.
World Neurosurg
December 2024
Neurosurgery Department, Hospital Clínic Barcelona, Barcelona, Spain.
Turk Neurosurg
November 2024
Karabuk University, Faculty of Medicine, Department of Neurosurgery, Karabuk, Türkiye.
Aim: To examine the fiber-based anatomy of the medial pontine area (MPA), one of the most commonly used brainstem (BS) safe entry zones in neurosurgery.
Material And Methods: According to the protocol of Klingler and Ludwig, six BSs were kept in 10% formalin solution for at least 2 months. After removing the arachnoid mater, pia mater, and vascular structures, the samples were frozen at -16°C for at least 2 weeks.
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