Cerebellar tonsillectomy with suboccipital decompression and duraplasty by small incision for Chiari I malformation (with syringomyelia): long term follow-up of 76 surgically treated cases.
OBJECTIVE
To explore the surgical effect of cerebellar tonsillectomy with suboccipital decompression and duraplasty by small surgical incision (3~4cm around the foramina magnum) on treating Chiari I Malformation (CM I) patients.


METHODS
A retrospective study was undertaken on 76 CM I patients treated by this surgery. The surgical efficacy on clinical symptoms and syringomyelia were overall evaluated and analyzed.


RESULTS
The study included 76 cases (36 men and 40 women; age range, 5-58 years; mean age at surgery, 38.8 years). Preoperative MRI confirmed 56 cases associated with syringomyelia. The follow-up period ranged from 25 to 58 months (median, 46 months). At the end of follow-up, 61 patients (80.26%) had improved, 12 patients (15.79%) were stabilized, and 3 patients (3.95%) had worsened. In MRI scan, syrinx of 55 patients (98.21%) had improved or stabilized compare with syrinx growth in only one patient (1.79%). Statistical analysis reveal the surgical effect tend to be much better in patients with short duration of preoperative symptoms (P=0.001).


CONCLUSIONS
Cerebellar tonsillectomy with suboccipital decompression and duraplasty can provide long-time cure for most CM I cases. Early diagnosis and surgery is necessary to improve the surgical effect. A 3~4cm incision around foramen magnum is enough for these operations and may be conducive to reduce postoperative complications.
West China Hospital, Department of Neurosurgery, P. R. China.
Junpeng
J
Ma
Chao
C
You
Haifeng
H
Chen
Siqing
S
Huang
Chengcheng
C
Ieong
D000293:Adolescent; D000328:Adult; D001139:Arnold-Chiari Malformation / Q000473:pathology / Q000601:surgery*; D002531:Cerebellum / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000379:methods*; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D012086:Reoperation; D012189:Retrospective Studies; D013595:Syringomyelia / Q000473:pathology / Q000601:surgery*; D055815:Young Adult