Title |
The surgical treatment of Chiari I malformation
|
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Published in |
Acta Neurochirurgica, July 1996
|
DOI | 10.1007/bf01411256 |
Pubmed ID | |
Authors |
J. Klekamp, U. Batzdorf, M. Samii, H. W. Bothe |
Abstract |
A retrospective study was undertaken on 133 patients with a Chiari I malformation treated within the last 16 years at the Departments of Neurosurgery at the Nordstadt Hospital Hannover, Germany, and the University of California, Los Angeles, U.S.A. Ninety-seven patients presented with symptoms related to accompanying syringomyelia and 4 with associated syringobulbia. They underwent 149 surgical procedures and were followed for a mean of 39 +/- 52 months. A decompression at the foramen magnum was performed in 124 patients, while 22 of those with syringomyelia were treated by shunting (7 syringosubarachnoid shunts, 15 syringoperitoneal or -pleural shunts), and 3 by ventriculoperitoneal shunts for hydrocephalus. Except for ventriculoperitoneal shunting, at least a short-term decrease in size of an associated syrinx was observed for all procedures in the majority of cases. However, no long-term benefit was observed for syrinx shunting operations. The best clinical long-term results were obtained with decompression of the foramen magnum in patients with (86% free of a clinical recurrence) and without syringomyelia (77% free of a clinical recurrence). We advise against syrinx shunting, a large craniectomy, and obex plugging which are associated with higher recurrence rates. Instead, surgery should consist of a small craniectomy, opening of the dura, archnoid dissection to establish normal cerebrospinal fluid (CSF) outflow from the 4th ventricle, and a fascia lata dural graft. |
Mendeley readers
Geographical breakdown
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United States | 1 | 2% |
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Demographic breakdown
Readers by professional status | Count | As % |
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Researcher | 9 | 21% |
Student > Postgraduate | 5 | 12% |
Other | 4 | 10% |
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Unknown | 10 | 24% |
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