Surgical Outcome of Chiari-I Malformation

Authors

  • NAQIB ULLAH ACHAKZAI Department of Neurosurgery, Bolan Medical College/ Sandeman Provincial Teaching Hospital, Quetta 87300 Pakistan
  • Irfan Adil Department of Neurosurgery, Bolan Medical College/ Sandeman Provincial Teaching Hospital, Quetta 87300 Pakistan
  • Saleem Khan Department of Neurosurgery, Bolan Medical College/ Sandeman Provincial Teaching Hospital, Quetta 87300 Pakistan

Keywords:

Chiari malformation, Tonsillar herniation, Foramen magnum decompression, Duroplasty, Chicago Chiari Outcome Scale (CCOS).

Abstract

Objective: To determine outcome in patients operated for Chiari-I Malformation.
Study: Descriptive case series.
Materials and Methods: Patients admitted in the Department of Neurosurgery, Bolan Medical College/ Hospital Quetta Pakistan from January 2013 to June 2017 with Chiari-I Malformation diagnosed on MRI and candidates for surgery based on consistent symptoms. MRI findings regarding cerebellar tonsillar termination in mm were recorded. Surgical Intervention consisted of suboccipitalcraniectomy, C1+/- C2 laminectomy(ies), reduction/ resection of cerebellar tonsil and expansion/augmentation duroplasty. Patients were followed-up after 6 months and outcome was determined by Chicago Outcome Scale for Chiari Malformation.
Data Analysis: SPSS version 20 software was used.
Results: Out of total of 39 patients 30 (77%) were females and 9 (23%) were males with Female to Male ratio of 3.3:1. Age ranged from 21 to 42 years. 35 (90%) patients presented with Valsalva headache, 34 (87%) with neckache, 25 (65%)with ataxia, 25 (65%) with paresthesia/numbness, 17 (44%) with sleep apnea, 16 (40%) with dysphagia, 15 (39%) with weakness, 12 (31%) with dizziness, 11 (27%) with visual disturbances, 9 (24%) with nausea/vomiting while 7 (18%) with tinnitus. 34 (88%) patients had tonsillar herniation more than 5mm while 5 (12%) had tonsillar herniation more than 10mm. Out of total of 39 patients 30 (77%) had good outcome while 9 (23%) had worse outcome.
Conclusions: Surgical decompression in Chiari-I Malformation should be offered to only those patients who are consistently symptomatic and their symptoms correlate with CM1. Surgery has favorable outcome in patients without significant cord damage and less severe neurological deficit before surgery.

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Published

2018-03-31

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