Delamination technique together with longitudinal incisions in Chiari 1/ syringomiyelia complex: a prospective clinical study.
Treatment modalities in Chiari malformation type 1(CMI) accompanied by syringomyelia have not yet been standardized. Pathologies like a small posterior fossa and thickened dura mater have already been discussed.
Various techniques have been explored to enlarge foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision of the external dura accompanied by widening the cisterna magna and making longitudinal incisions in the internal dura without disturbing the arachnoid.
Methods: A prospective series of 10 cases with CMI and syringomyelia, operated between 2004 and 2006 were included in this study.
All cases underwent foramen magnum decompression of 3x3 cm area with C1-C2 (partial) laminectomy, resection of foramen magnum fibrous band, excision of external dura, delamination and widening of internal dura with longitudinal incisions.
Results: Patients were aged between 25 and 58 years and occipital headache was the most common complaint. The mean duration of preoperative symptoms was 4 years and the mean follow-up time was 25 months.
Clinical progression was halted for all patients; eight patients completely recovered and two reported no change. In one patient, there was a transient CSF fistula that was treated with tissue adhesive.
While syringomyelia persisted radiologically with radiological stability in five patients; for three patients the syringomyelic cavity decreased in size, and for the remaining two it regressed completely.
Conclusion: Removal of the fibrous band and the outer dural layer, at level of foramen magnum, together with the incision of inner dural layer seems to be good technique in adult CMI patients. Advantages are short operation time, no need for duraplasty, sufficient posterior fossa decompression, absence of CSF fistulas as a result of extraarachnoidal working, and short duration of hospitalization.
Hence this surgical technique has advantages compared to other techniques.
Author: Kadir KotilRabia TariTugrul TonYildiray Savas
Credits/Source: Cerebrospinal Fluid Research 2009, 6:7
Published on: 2009-06-22
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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