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Fourth ventricle stent placement for treatment of type I Chiari malformation in children
Peng Sun1, Mading Zhou1, Yutong Liu1
1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Fourth ventricle stenting (FVS) effectively relieved syringomyelia in children with Chiari malformation Type I (CM-I). This safe procedure showed symptom improvement and no major complications in a small case series.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Cerebrospinal Fluid Dynamics
Background:
- Type I Chiari malformation (CM-I) is a congenital condition often leading to syringomyelia due to cerebrospinal fluid (CSF) obstruction at the foramen magnum.
- Syringomyelia, a fluid-filled cavity within the spinal cord, can cause significant neurological deficits.
Purpose of the Study:
- To evaluate the efficacy and safety of Fourth Ventricle Stenting (FVS) as a treatment for syringomyelia in children with CM-I.
- To determine appropriate indications for FVS in pediatric CM-I patients.
Main Methods:
- A retrospective review of four pediatric patients with CM-I who underwent FVS implantation between November 2021 and July 2022.
- FVS utilized an Ommaya reservoir ventricular catheter, with duraplasty using autologous fascia.
- Post-operative assessment included cervical MRI at 3 months and clinical follow-up.
Main Results:
- Four children (1 boy, 3 girls; aged 12 months to 10 years) received FVS.
- No major complications were reported.
- Follow-up MRI demonstrated attenuation of syringomyelia and/or hydrocephalus in all patients, with no new symptoms during a mean 10.8-month follow-up.
Conclusions:
- Fourth Ventricle Stenting (FVS) is a safe and effective surgical option for managing CM-I with syringomyelia in children.
- Indications for FVS include complex cases, such as redo-FMD, persistent CSF flow issues at the foramen magnum, and obstructive hydrocephalus.
- Long-term follow-up is essential to confirm sustained efficacy.
Introduction:
Type I Chiari malformation (CM-I) is a common congenital malformation, often accompanied by syringomyelia. Obstruction of CSF circulation in the foramen magnum is the reason for the formation of the syringomyelia. Fourth ventricle stenting (FVS) could ensure the CSF flow from the fourth ventricle, which might represent an effective approach to achieve syringomyelia relief.
Methods:
We have reviewed four cases of CM-I children who received FVS implantation from November 2021 to July 2022. Each of the patients underwent FMD. The ventricular catheter of an Ommaya reservoir (Medtronic, Inc.) was used as a stent. Duraplasty was performed with autologous fascia. Cervical MRI rechecks were routinely done 3 months later, and the clinical symptoms were followed up.
Results:
Four children received FVS, including one boy and three girls, aged from 12 months to 10 years, with a mean age of 6.8 years. No major complication occurred. The syringomyelia or hydrocephalus in each patient were all attenuated, as observed on the reexamination MRI images. During the follow-up time with a mean of 10.8 months, no patient had new symptoms.
Conclusion:
FVS is an effective and safe method for operation of CM-1 in children. The indications of FVS include redo-FMD, difficulties to ensure post-FMD CSF circulation patency at the foramen magnum and with obstructive hydrocephalus. A long-term follow-up duration is necessary.
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