Long-term follow-up of Chiari-related syringomyelia in adults: analysis of 157 surgically treated cases.
OBJECTIVE
To determine the long-term outcome of surgically treated Chiari-related syringomyelia.


METHODS
The medical charts of 157 consecutive surgically treated patients with Chiari-related syringomyelia were retrospectively analyzed. Factors predicting outcome, either clinical or radiological, are discussed, and our results are compared with those of other large series in the literature.


RESULTS
The study included 74 men and 83 women (age range, 16-75 years; mean age at surgery, 38.3 years). Pain and sensory disturbance were the most frequent initial symptoms. The average duration of preoperative symptoms was 8.2 years. The follow-up period ranged from 82 to 204 months (median, 88 months). At the end of the study, 99 patients (63.06%) had improved, 48 (30.58%) had stabilized, 9 (5.73%) had worsened, and 1 (0.63%) had died during the postoperative period. Factors predicting improvement or stabilization were young age at the time of surgery and clinical signs of paroxysmal intracranial hypertension. Factors associated with a poor outcome were older age at the time of surgery, arachnoiditis, and a clinical feature of long-tract impairment syndrome. The presence of arachnoiditis or of basilar invagination was associated with poor clinical presentation (P = 0.05 and 0.0001, respectively). The extent of the cyst on postoperative magnetic resonance imaging was a predictor of poor clinical outcome (P = 0.002).


CONCLUSIONS
Our results confirmed that surgery is an effective and safe treatment of Chiari-related syringomyelia, with a 90% chance of long-term stabilization or improvement on average. Surgery should be proposed as soon as possible in patients with clearly progressing clinical features.
Aghakhani
Nozar
N
Department of Neurosurgery, Bicêtre University Hospital, Bicêtre, France. Nozar.aghakhani@bct.aphp.fr
Parker
Fabrice
F
David
Philippe
P
Morar
Silvia
S
Lacroix
Catherine
C
Benoudiba
Farida
F
Tadie
Marc
M
D000293:Adolescent; D000328:Adult; D001139:Arnold-Chiari Malformation / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013595:Syringomyelia / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult