title: Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation.
abstract: The wide spectrum of symptoms and radiographic findings in patients with Chiari I malformation makes the decision to proceed with intervention controversial. We evaluated symptomatic outcomes using diverse surgical techniques in 104 patients who underwent decompression surgery. The symptoms of most patients improved. Patients with syringomyelia showed less symptomatic improvement; however, syringomyelia was not associated with postoperative symptomatic worsening. Durotomy was performed in 97.1% and arachnoid opening was performed in 60.6% with visualization of the fourth ventricle in 51.9% of patients. Neither arachnoid opening nor fourth ventricle visualization was associated with the clinical outcome. Duraplasty was performed in 94.2% of patients. A Chiari plate was used in 13.4% of patients and was associated with favorable outcomes. Use of postoperative steroids or muscle relaxants was not associated with outcome. Syringomyelia showed a 62.5% improvement rate on postoperative MRI. In conclusion, bony decompression and dural opening are important aspects of Chiari I surgery, with symptomatic improvement observed in most patients.
authors: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
authors: Samuel
authors: S
authors: Kalb
authors: Luis
authors: L
authors: Perez-Orribo
authors: Mark
authors: M
authors: Mahan
authors: Nicholas
authors: N
authors: Theodore
authors: Peter
authors: P
authors: Nakaji
authors: Ruth E
authors: RE
authors: Bristol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000601:surgery; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D020546:Fourth Ventricle / Q000601:surgery; D006801:Humans; D007223:Infant; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications; D013595:Syringomyelia / Q000150:complications; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult