Surgical decompression for symptomatic Chiari II malformation in neonates with myelomeningocele.
Between January, 1981, and July, 1991, 17 infants under 1 month of age were admitted to The Hospital for Sick Children with the signs and symptoms of a Chiari II malformation. These patients' presentation included swallowing difficulty (71%), stridor (59%), apneic spells (29%), aspiration (12%), weakness of cry (18%), and arm weakness (53%). Decompression of the Chiari II malformation was performed in all patients, with a time interval between onset of symptoms and surgery ranging from 1 to 121 days. Fifteen patients (88%) remain alive, all of whom have shown a complete recovery. The mean follow-up period in this group of patients was 65 months. Two patients died, one due to respiratory arrest 8 months after decompression and the other because of shunt infection and peritonitis 7 years after decompression. These results support the concept that compressive forces, rather than a primary intrinsic disorder of the brain-stem nuclei, play a crucial etiological role in the development of a symptomatic Chiari II malformation. Early recognition of the symptoms of Chiari II malformation should be followed by immediate decompressive laminectomy in order to promote a prompt and full neurological recovery.
Vandertop
W P
WP
Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Asai
A
A
Hoffman
H J
HJ
Drake
J M
JM
Humphreys
R P
RP
Rutka
J T
JT
Becker
L E
LE
D001139:Arnold-Chiari Malformation / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D015996:Survival Rate