title: Suboccipital craniectomy with opening of the fourth ventricle and duraplasty: study of 192 cases of craniovertebral malformations.
abstract: The prime objective in the surgical treatment of basilar impression (BI), Chiari malformation (CM), and/or syringomyelia (SM) is based on restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction and creation of a large artificial cisterna magna, avoiding the caudal migration of the hindbrain. It is observed that a large craniectomy might facilitate an upward migration of the posterior fossa structures. There are many surgical techniques to decompress the posterior fossa; however, a gold standard approach remains unclear. The authors present the results of 192 cases of BI, CM, and SM treated between 1975 and 2008 and whose surgical treatment was characterized by a large craniectomy without tonsillectomy with the patient in the sitting position, large opening of the fourth ventricle, and duraplasty.
authors.affiliation: Neurosurgical Division, Hospital Unimed, João PessoaPB, Brazil.
authors.forename: José Alberto Gonçalves da
authors.initials: JA
authors.lastname: Silva
authors.forename: Adailton Arcanjo dos
authors.initials: AA
authors.lastname: Santos
authors.forename: Maria do Desterro Leiros da
authors.initials: Mdo D
authors.lastname: Costa
authors.forename: Everardo Bandeira de
authors.initials: EB
authors.lastname: Almeida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods*; D004388:Dura Mater / Q000601:surgery; D005260:Female; D020546:Fourth Ventricle / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010985:Platybasia / Q000601:surgery*; D012189:Retrospective Studies; D013595:Syringomyelia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult