Surgical results of posterior fossa decompression for patients with Chiari I malformation.
BACKGROUND
An increasing number of children with Chiari I malformations are coming to the attention of neurosurgeons today, although a consensus on the surgical approach to these lesions has yet to be found.


METHODS
We present a retrospective analysis of posterior fossa decompression (PFD) performed at our institution on 96 patients from 1989 to 2001. Statistical analyses based on clinical and radiographic presentation and the types of surgical procedures used formed the basis for our review.


RESULTS
Most of the patients with hydromyelia underwent duraplasty procedures with or without tonsillar manipulation. In contrast, most patients without hydromyelia underwent bony decompression with dural scoring and intraoperative ultrasound. PFD with bony decompression and dural scoring showed a 72% success rate, compared with 68% for duraplasty. Dural opening was not more likely to improve or arrest hydromyelia. The group subjected to duraplasty, however, had a significantly higher complication rate. Patients under the age of 8 fared better than their older counterparts.


CONCLUSIONS
Overall, we favor a tailored posterior fossa craniectomy with dural scoring as the initial surgical procedure in children with Chiari I malformation with or without a syrinx. This less invasive approach minimizes complications associated with dural opening and offers comparable success rates.
Navarro
Ramon
R
Division of Pediatric Neurosurgery, Children's Memorial Hospital, Northwestern University Medical School, 2300 Children's Plaza, Box #28, Chicago, IL 60614, USA.
Olavarria
Greg
G
Seshadri
Roopa
R
Gonzales-Portillo
Gabriel
G
McLone
David G
DG
Tomita
Tadanori
T
D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D019299:Decompression, Surgical; D004388:Dura Mater / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D013595:Syringomyelia / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome