Management opinions from different centers (Rio de Janeiro)

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Surgical treatment for Chiari type 1 malformation (CM1) remains controversial, with techniques varying by surgeon preference.
• Advances in neuroimaging have led to increased incidental diagnoses of asymptomatic CM1.
• Patient symptoms often include headache, neck pain, and may involve hydrosyringomyelia or spinal cord issues.

Purpose of the Study:

• To retrospectively evaluate the outcomes of 24 symptomatic CM1 patients treated between 1999 and 2017.
• To assess the utility of intraoperative ultrasonography (IOUS)-assisted posterior fossa-C1 decompression in guiding surgical decisions regarding dural opening (CVD+ vs. CVD).

Main Methods:

• Retrospective analysis of 24 symptomatic CM1 patients.
• Surgical intervention involved IOUS-assisted posterior fossa-C1 decompression.
• Dural opening decision (CVD+ or CVD) was guided by IOUS findings.
• Patient outcomes were categorized as improved, unchanged, or worse based on preoperative symptoms.

Main Results:

• Overall, 19 out of 24 patients experienced improvement in their condition.
• Three patients deteriorated, and two remained unchanged post-surgery.
• Syringohydromyelia was present in 4 out of 5 patients who had it preoperatively.
• Patients undergoing intradural procedures, whether initially or subsequently, faced higher rates of postoperative complications.

Conclusions:

• Intraoperative ultrasonography (IOUS)-assisted posterior fossa-C1 decompression is a preferred surgical approach for CM1.
• Opening the dura mater during CM1 surgery is associated with increased postoperative complications, such as CSF fistula or pseudomeningocele.
• The preoperative neurological status appears to be a significant factor correlating with the final surgical outcome in CM1 patients.