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J Neurol Surg A Cent Eur Neurosurg 2017; 78(04): 344-349
DOI: 10.1055/s-0037-1599841
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Symptomatic Outcome after Bone-only Suboccipital Decompression in Adult Patients with Chiari Type I Malformations in the Absence of Hydromyelia or Hydrocephalus

Nicolas Olmo Koechlin
1   Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
2   Endoskopische und Minimal Invasive Neurochirurgie, Klinik Birshof, Munchenstein, Switzerland
,
Hazem J. Abuhusain
1   Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
,
Manuri Gunawardena
1   Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
,
Tyler S. Auschwitz
1   Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
3   Department of Neurosurgery, University of Tennessee Health Science Center, Tennessee, United States
,
Charles Teo
4   Department of Neurosurgery, Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

24 February 2016

30 December 2016

Publication Date:
24 April 2017 (online)

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Abstract

Background Type I Chiari malformation presents without an associated hydromyelia in 30 to 70% of cases, yet there is no agreement regarding the optimal surgical treatment for these patients. We review our experience for treating symptomatic adult type I Chiari malformation without hydromyelia using a suboccipital bone decompression of the hindbrain and no duraplasty in 12 adult patients. Outcome was measured according to the Chicago Chiari Outcome Scale (CCOS).

Results Nine of 12 patients were female; average age at surgery was 34.4 years (range: 17–67 years). Average duration of symptoms prior to surgery was 9.6 years (2 months–29 years). The most common symptom was head and/or neck pain (11/12 patients). All patients additionally presented with at least one non-pain symptom. Mean degree of tonsillar herniation on magnetic resonance imaging was 6.8 mm (range: 5–12 mm) below McRae's line. Operative time was on average 68 minutes (range: 47–120 minutes). No surgical complications were noted in any patient. Length of hospital stay was 2 days (1 overnight) for all patients. Mean follow-up was 167 weeks (range: 13–378 weeks). CCOS for all patients on average was 14.50 (range: 12–16). Pain symptoms underwent improvement (7/11 [63.6%]) or complete resolution (4/11 [36.4%]) in all affected patients. A shorter duration of preoperative symptoms significantly correlated with a better CCOS (p = 0.03). Degree of tonsillar herniation had no significant effect on CCOS (p = 0.67). Of non-pain symptoms, paresthesias/dysesthesias and visual symptoms improved or resolved completely in all affected patients. No patient experienced a worsening of either pain or non-pain symptoms.

Conclusion In the subset of adult patients with a type I Chiari malformation and no associated hydromyelia, a craniectomy without an additional opening of the dura may achieve good overall results according to the CCOS.

Keywords

Arnold-Chiari malformation type I - decompressive craniectomy - neurosurgery - minimally invasive surgery - hydromyelia
 

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