title: Posterior fossa decompression combined with resection of the cerebellomedullary fissure membrane and expansile duraplasty: a radical and rational surgical treatment for Arnold-Chiari type I malformation.
abstract: This study aims to introduce a new surgical procedure for the treatment of Arnold-Chiari type I malformation (ACM-1) and to compare its effectiveness with the techniques described in previous studies. We performed the following procedures: foramen magnum decompression combined with the removal of both the atlanto-occipital membrane, extended resection of the cerebellomedullary fissure arachnoid membrane, and artificial duraplasty to enlarge the membranic posterior fossa without resecting the cerebellar tonsils and syringosubarachnoid shunting. There were 21 ACM-1 patients: 12 cases had osteo-compression on the cerebellar hemisphere, 18 cases had thickened adhered fabric ring that stretched from arachnoid membrane to cerebellar hemisphere, and 15 cases with syringomyelia. The patients were followed up for 6 months to 3 years after the surgery. All patients showed a remarkable recovery of syringomyelia. There were no morbidity or death related to the surgery. Most of ACM-1 patients, the osteo- and membrane compression on cerebellar hemisphere and tonsil were observed during the operation. Therefore, decompression of foramen magnum and posterior craniocervical combined with the removal of cerebellomedullary fissure arachnoid membrane and placement of an artificial dural graft should be considered as a comprehensive option of minimally invasive surgery and rational and radical treatment of ACM-1. Our experience showed that, by using our procedure, shunting becomes no longer necessary in the treatment of ACM-1-associated syringomyelia.
authors.affiliation: Department of Neurosurgery, The Affiliated Futain Hospital of Guangdong Medical College, The Fourth Hospital of Shenzhen, Shenzhen, P.O. 0086 518033, Guangdong, People's Republic of China, szftsjwk@163.com.
authors.forename: Chen Jian
authors.initials: CJ
authors.lastname: Liang
authors.forename: Qiu Jian
authors.initials: QJ
authors.lastname: Dong
authors.forename: You Heng
authors.initials: YH
authors.lastname: Xing
authors.forename: Ma
authors.initials: M
authors.lastname: Shan
authors.forename: Lian Xiao
authors.initials: LX
authors.lastname: Wen
authors.forename: Zhong Yuan
authors.initials: ZY
authors.lastname: Qiang
authors.forename: Zhang Qing
authors.initials: ZQ
authors.lastname: Ping
authors.forename: Peng Zhi
authors.initials: PZ
authors.lastname: Tao
authors.forename: Huang Xiao
authors.initials: HX
authors.lastname: Ping
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D005260:Female; D005539:Foramen Magnum / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013595:Syringomyelia / Q000150:complications / Q000175:diagnosis