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Updated: Nov 4, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Long-term outcomes of surgical management in subtypes of Chiari malformation
Recep Basaran1, Caglar Bozdogan2, Mehmet Senol2
1University of Health Sciences Sancaktepe Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.
Insights
This study analyzes Chiari malformations (CMs) types 0, 1, and 1.5, finding that cerebellar tonsillar ectopia (CVD) surgery is effective. Outcomes depend on surgical procedure, syringomyelia (SM) presence, and symptom duration.
Area of Science:
- Neurosurgery
- Neurology
- Medical Genetics
Background:
- Chiari malformations (CMs) encompass a spectrum of hindbrain anomalies affecting the cerebellum, brainstem, and craniovertebral junction.
- Understanding the diverse subtypes, including CM-0, CM-1, and CM-1.5, is crucial for effective diagnosis and treatment.
Purpose of the Study:
- To investigate the demographic, clinical, and epidemiological features of CM subtypes.
- To evaluate surgical procedures and patient outcomes for CM-0, CM-1, and CM-1.5.
- To identify factors influencing treatment success in a large patient cohort.
Main Methods:
- Retrospective analysis of 191 patients diagnosed with CM-0, CM-1, or CM-1.5 between 1985 and 2016.
- Detailed recording of demographic data, clinical presentations, surgical interventions, and post-operative outcomes.
- Radiological assessment of syringomyelia (SM) and correlation with clinical status.
Main Results:
- The cohort included 15 CM-0 (7.8%), 121 CM-1 (63.4%), and 55 CM-1.5 (28.8%) cases.
- Cerebellar tonsillar descent (CVD) surgery resulted in improved outcomes for 65.8% of patients.
- Syringomyelia (SM) was present in a significant portion of patients, with its presence and symptom duration impacting outcomes.
Conclusions:
- CM-1.5 presents distinct symptomatic patterns compared to CM-1.
- Cerebellar tonsillar descent (CVD) surgery is a safe and effective procedure for CM-0, CM-1, and CM-1.5.
- Surgical approach, syringomyelia (SM) presence, and symptom duration are critical determinants of patient outcomes.
Abstract:
Objective: Chiari malformations (CMs) are a heterogeneous group of disorders defined by anatomic anomalies of the cerebellum, brainstem, and craniovertebral junction (CVJ). The aims of this study are to establish the demographic and clinical features, incidence, surgical procedures, and outcomes in large series of old and new subtypes of CMs.Material and Methods: All patients were evaluated and operated on for CM-0, 1, and 1.5 between 1985 and 2016. The patients were grouped into various subtypes. Demographic data, additional diseases, clinical features, surgical procedures, complications and outcomes were recorded.Results: 191 patients who underwent various surgical procedures were evaluated. Their mean age was 37.21 ± 9.89. We detected 15 cases of CM-0 (7.8%), 121 cases of CM-1 (63.4%), 55 cases of CM-1.5 (28.8%). In total there were 191 cases, and 220 surgical procedures were performed. 29 (13.2%) of all surgical procedure was reoperations and secondary operations. SM Cyst is found to be decreased in 72 (76.5%) patients, unchanged in 14 (14.8%) and increased in 8(8.5%) of 94 patients radiologically. Clinical outcomes are better for 131 (65.8%), same for 31 (16.2%) and worse for 9 (15%).Conclusion: This study with 172 patients is a large series that includes CM-0, 1, and 1.5 subtypes. CM-1.5 also differs for symptom presentation and durations from CM-1. There are more neurological abnormalities in patients with SM. CVD alone are an effective, useful and safe surgical procedure for CM-0, CM-1 and CM-1.5. Surgical procedure, SM existence, and symptom duration have powerful effects on outcomes.
