title: Clinical and radiological outcome of craniocervical osteo-dural decompression for Chiari I-associated syringomyelia.
abstract: The aim of this study was to analyze the long-term clinical and radiological outcomes of craniocervical decompression for patients affected by Chiari I-related syringomyelia. We performed a retrospective analysis of a group of patients affected by Chiari I-associated syringomyelia treated by craniocervical decompression (CCD). Surgical and technical aspects and preoperative factors predicting outcome were discussed. A total of 36 patients were reviewed. There were 17 men and 19 women (female/male ratio 1.11), and the mean age was 40.4 (range 18-68). The most important preoperative symptoms were related to myelopathy (pain, weakness, atrophy, spasticity, sensory loss, and dysesthesias). Most syrinxes were in the cervico-thoracic region (61.1%), and the majority of patients had tonsillar descent between the foramen magnum and C1. All patients underwent a craniectomy less than 3 cm in diameter followed by a duroplasty with dura substitute. No arachnoid manipulation was necessary. Three patients (8.1%) experienced cerebrospinal fluid leaks that resolved without complications. At a mean follow up of 40 months (range 16-72) 80.5% of patients exhibited improvement over their preoperative neurological examination while 11.1% stabilized. The syrinx shrank in 80.5% of patients. Chi-square test showed that preoperative syrinx extension and degree of tonsillar descent did not correlate with clinical and neuroradiological postoperative evolution. Treating syringomyelia associated in Chiari I malformation with CCD leads to a large percentage of patients with satisfying results and no irreversible complications.
authors.affiliation: Division of Neurosurgery, Civil Hospital, Alessandria, Italy. giannantonios@hotmail.com
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Spena
authors.forename: Claudio
authors.initials: C
authors.lastname: Bernucci
authors.forename: Diego
authors.initials: D
authors.lastname: Garbossa
authors.forename: Walter
authors.initials: W
authors.lastname: Valfrè
authors.forename: Pietro
authors.initials: P
authors.lastname: Versari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical; D004388:Dura Mater / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000473:pathology; D011859:Radiography; D013131:Spine / Q000601:surgery; D013595:Syringomyelia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult