J Neurol Surg B Skull Base 2024; 85(02): 202-211
DOI: 10.1055/a-2127-0094
Orginal Article

Neuroendoscopy-Assisted Minimal Invasive Management of Chiari 1 Malformation

Göksal Günerhan
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Emin Çağıl
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Zeynep Dağlar
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Uğur Kemal Gündüz
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Ali Dalgıç
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Ahmet Deniz Belen
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
› Author Affiliations
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Abstract

Objective The aim this study is to present the results of the minimal invasive neuroendoscopic-assisted system application as an alternative to traditional surgery in patients with Chiari malformation type 1 (CM type 1) with/without syringomyelia.

Design, Setting, and Participants In the study, data of 22 symptomatic patients were prospectively collected. Before and after the operation, patient characteristics, computed tomography, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow dynamics MRI, and outcome scales scores were recorded. Foramen magnum decompression and C1 total laminectomy were performed. The fibrous band at the craniocervical junction was opened and a durotomy was performed. In patients with a syrinx, the pre- and postoperative axial and sagittal lengths of the syrinx were measured and compared.

Results The mean age of the patients was 32 ± 5 years. There were eight male patients. Ten patients had syrinx. The mean visual analog scale (VAS) score before and after surgery was 8 ± 1.06 and 2.18 ± 1.13, respectively. When evaluated according to the Chicago Chiari Outcome Scale, there was improvement in 20 patients, while there was no change in 2 patients. Syrinx resolved completely in 3 of 10 (13.6%) patients with syringomyelia, and the syrinx volume decreased in 3 patients (13.6%). In 4 of 10 (18.1%) patients, there was no significant change in the syrinx volume. The average operation time was 105 minutes (80–150 minutes). The average blood loss was 40 mL (20–110 mL).

Conclusion Although the study was limited due to the small number of patients with a short follow-up, endoscopic decompression was a safe and effective technique for surgery in CM type 1 patients.

Ethical Approval

This study was approved by the Institutional Review Board (TUEK E1–22–2615), and written informed consent was obtained from each patient.


Authors' Contributions

Conceptualization was done by G.G. and E.Ç.. Investigation was done by G.G., E.Ç., and Z.D.. Project administration was done by ADB and AD. GG, AD, and UKG were responsible for the resources. Surgery was performed by GG. Writing of the original draft was done E.Ç., Z.D., and U.K.G.. G.G., A.D., A.D.B. contributed to the writing, review, and editing of the manuscript.




Publication History

Received: 02 April 2023

Accepted: 08 July 2023

Accepted Manuscript online:
11 July 2023

Article published online:
11 August 2023

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