Skip to main content
SpringerLink
Log in

Bony Decompression for Chiari Malformation Type I: Long-Term Follow-Up

  • Chapter
  • First Online:
New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

Background: Several surgical techniques are used for the management of Chiari malformation type I (CM-I). Bony posterior fossa decompression is considered a good option in children, though with a higher risk of requiring reoperation. However, there is not enough evidence from the series in the literature, which are often limited by inadequate follow-up. The goal of this study was to assess the effectiveness of suboccipital craniectomy alone in children after long-term follow-up.

Methods: Forty-two children (25 female and 17 male; mean age 6.7 years), operated on with bony decompression alone, were retrospectively reviewed. All patients underwent suboccipital craniectomy. Thirty-eight children required C1 laminectomy, and 21 also underwent dural delamination on the basis of intraoperative ultrasound investigations. The outcome was assessed using the traditional measurement and the Chicago Chiari Outcome Scale (CCOS). The mean follow-up period was 11.3 years (range 5–15 years).

Results: Headache was the most frequent preoperative symptom (81%), followed by neck pain (40%), vertigo (40%), ataxia (26%), and upper and lower extremity paraesthesia (26%). Syringomyelia was present in 19 patients (45%). Resolution and significant improvement of preoperative clinical symptoms were observed in 36.5% and 21.5% of cases, respectively. Three children required adjunctive surgery for symptom recurrence (7%). The tonsil position and syringomyelia were normalized or improved in 50% and 79% of cases, respectively. No complications occurred. According to the CCOS scores, 69.5% of children had an excellent outcome, 28.5% had a functional outcome and 2% had an impaired outcome.

Conclusion: Bony decompression alone is an effective, safe and long-lasting treatment for children with CM-I. A certain risk of symptom recurrence requiring new surgery exists, but it is widely counterbalanced by the low risk of complications. Careful patient selection is crucial for a good outcome. Prospective and randomized studies are needed for further validation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Albert GW, Menezes AH, Hansen DR, Greenlee JD, Weinstein SL. Chiari malformation type I in children younger than age 6 years: presentation and surgical outcome. J Neurosurg Pediatr. 2010;5:554–61.

    Article  Google Scholar 

  2. Beecher JS, Liu Y, Qi X, Bolognese PA. Minimally invasive subpial tonsillectomy for Chiari I decompression. Acta Neurochir. 2016;158:1807–11.

    Article  Google Scholar 

  3. Chauvet D, Carpentier A, George B. Dura splitting decompression in Chiari type 1 malformation: clinical experience and radiological findings. Neurosurg Rev. 2009;32:465–70.

    Article  Google Scholar 

  4. Di X. Endoscopic suboccipital decompression on pediatric Chiari type I. Minim Invasive Neurosurg. 2009;52:119–25.

    Article  CAS  Google Scholar 

  5. Hankinson TC, Grunstein E, Gardner P, Spinks TJ, Anderson RC. Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with Chiari malformation type I and ventral brainstem compression. J Neurosurg Pediatr. 2010;5:549–53.

    Article  Google Scholar 

  6. Massimi L, Caldarelli M, Paternoster G, Novegno F, Tamburrini G, Di Rocco C. Mini-invasive surgery for Chiari type I malformation. Neuroradiol J. 2008;21:65–70.

    Article  CAS  Google Scholar 

  7. Parker SR, Harris P, Cummings TJ, George T, Fuchs H, Grant G. Complications following decompression of Chiari malformation type I in children: dural graft or sealant? J Neurosurg Pediatr. 2011;8:177–83.

    Article  Google Scholar 

  8. Sindou M, Gimbert E. Decompression for Chiari type I-malformation (with or without syringomyelia) by extreme lateral foramen magnum opening and expansile duraplasty with arachnoid preservation: comparison with other technical modalities (literature review). Adv Tech Stand Neurosurg. 2009;34:85–110.

    Article  CAS  Google Scholar 

  9. Tubbs RS, Beckman J, Naftel RP, Chern JJ, Wellons JC, Rozzelle CJ, Blount JP, Oakes WJ. Institutional experience with 500 cases of surgically treated pediatric Chiari malformation type I. J Neurosurg Pediatr. 2011;7:248–56.

    Article  Google Scholar 

  10. Greenberg JK, Milner E, Yarbrough CK, Lipsey K, Piccirillo JF, Smyth MD, Park TS, Limbrick DD Jr. Outcome methods used in clinical studies of Chiari malformation type I: a systematic review. J Neurosurg. 2015;122:262–72.

    Article  Google Scholar 

  11. Aliaga L, Hekman KE, Yassari R, Straus D, Luther G, Chen J, Sampat A, Frim D. A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery. 2012;70:656–65.

    Article  Google Scholar 

  12. Wilkinson DA, Johnson K, Garton HJ, Muraszko KM, Maher CO. Trends in surgical treatment of Chiari malformation type I in the United States. J Neurosurg Pediatr. 2016;11:1–9.

    Article  Google Scholar 

  13. Förander P, Sjåvik K, Solheim O, Riphagen I, Gulati S, Salvesen Ø, Jakola AS. The case for duraplasty in adults undergoing posterior fossa decompression for Chiari I malformation: a systematic review and meta-analysis of observational studies. Clin Neurol Neurosurg. 2014;125:58–64.

    Article  Google Scholar 

  14. Gürbüz MS, Berkman MZ, Ünal E, Akpınar E, Gök Ş, Orakdöğen M, Aydın S. Foramen magnum decompression and duraplasty is superior to only foramen magnum decompression in Chiari malformation type 1 associated with syringomyelia in adults. Asian Spine J. 2015;9:721–7.

    Article  Google Scholar 

  15. Rehman L, Akbar H, Bokhari I, Babar AK, M Hashim AS, Arain SH. Posterior fossa decompression with duraplasty in Chiari-1 malformations. J Coll Physicians Surg Pak. 2015;25:254–8.

    PubMed  Google Scholar 

  16. Xu H, Chu L, He R, Ge C, Lei T. Posterior fossa decompression with and without duraplasty for the treatment of Chiari malformation type I—a systematic review and meta-analysis. Neurosurg Rev. 2016;40(2):213–21.

    Article  Google Scholar 

  17. Hankinson T, Tubbs RS, Wellons JC. Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation. Childs Nerv Syst. 2011;27:35–40.

    Article  Google Scholar 

  18. Foreman P, Safavi-Abbasi S, Talley MC, Boeckman L, Mapstone TB. Perioperative outcomes and complications associated with allogeneic duraplasty for the management of Chiari malformations type I in 48 pediatric patients. Neurosurg Pediatr. 2012;10:142–9.

    Article  Google Scholar 

  19. Ma J, You C, Chen H, Huang S, Ieong C. Cerebellar tonsillectomy with suboccipital decompression and duraplasty by small incision for Chiari I malformation (with syringomyelia): long term follow-up of 76 surgically treated cases. Turk Neurosurg. 2012;22:274–9.

    CAS  PubMed  Google Scholar 

  20. Caldarelli M, Novegno F, Massimi L, Romani R, Tamburrini G, Di Rocco C. The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation type I: experience with a pediatric series. J Neurosurg. 2007;106(3 Suppl):187–95.

    PubMed  Google Scholar 

  21. Genitori L, Peretta P, Nurisso C, Macinante L, Mussa F. Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases. Childs Nerv Syst. 2000;16:707–18.

    Article  CAS  Google Scholar 

  22. Kennedy BC, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Anderson RC, Feldstein NA. Outcomes after suboccipital decompression without dural opening in children with Chiari malformation type I. J Neurosurg Pediatr. 2015;16:150–8.

    Article  Google Scholar 

  23. Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD. Comparison of posterior fossa decompression with or without duraplasty in children with type I Chiari malformation. Childs Nerv Syst. 2014;30:1419–24.

    Article  Google Scholar 

  24. Limonadi FM, Selden NRJ. Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. J Neurosurg. 2004;101:184–8.

    PubMed  Google Scholar 

  25. Navarro R, Olavarria G, Seshadri R, Gonzales-Portillo G, McLone DG, Tomita T. Surgical results of posterior fossa decompression for patients with Chiari I malformation. Childs Nerv Syst. 2004;20:349–56.

    Article  Google Scholar 

  26. Korshunov AE, Kushel’ YV. Posterior decompression of the craniovertebral junction in children with Chiari malformation: a surgery extent issue [in Russian]. Zh Vopr Neirokhir Im N N Burdenko. 2016;80:13–20.

    Article  CAS  Google Scholar 

  27. Durham SR, Fjeld-Olenec K. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr. 2008;2:42–9.

    Article  Google Scholar 

  28. Mutchnick IS, Janjua RM, Moeller K, Moriarty TM. Decompression of Chiari malformation with and without duraplasty: morbidity versus recurrence. J Neurosurg Pediatr. 2010;5:474–8.

    Article  Google Scholar 

  29. Shweikeh F, Sunjaya D, Nuno M, Drazin D, Adamo MA. National trends, complications, and hospital charges in pediatric patients with Chiari malformation type I treated with posterior fossa decompression with and without duraplasty. Pediatr Neurosurg. 2015;50:31–7.

    Article  Google Scholar 

  30. Chotai S, Medhkour A. Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I. Clin Neurol Neurosurg. 2014;125:182–8.

    Article  Google Scholar 

  31. McGirt MJ, Nimjee SM, Floyd J, Bulsara KR, George TM. Correlation of cerebrospinal fluid flow dynamics and headache in Chiari I malformation. Neurosurgery. 2005;56:716–21.

    Article  Google Scholar 

  32. McGirt MJ, Nimjee SM, Fuchs HE, George TM. Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations. Neurosurgery. 2006;59:140–6.

    Article  Google Scholar 

  33. Narenthiran G, Parks C, Pettorini B. Management of Chiari I malformation in children: effectiveness of intra-operative ultrasound for tailoring foramen magnum decompression. Childs Nerv Syst. 2015;31:1371–6.

    Article  Google Scholar 

  34. Yeh DD, Koch B, Crone KR. Intraoperative ultrasonography used to determine the extent of surgery necessary during posterior fossa decompression in children with Chiari malformation type I. J Neurosurg. 2006;105(1 Suppl):26–32.

    PubMed  Google Scholar 

  35. McGirt MJ, Attenello FJ, Datoo G, Gathinji M, Atiba A, Weingart JD, Carson B, Jallo GI. Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with Chiari malformation type I. J Neurosurg Pediatr. 2008;2:52–7.

    Article  Google Scholar 

  36. Bond AE, Jane JA Sr, Liu KC, Oldfield EH. Changes in cerebrospinal fluid flow assessed using intraoperative MRI during posterior fossa decompression for Chiari malformation. J Neurosurg. 2015;122:1068–75.

    Article  Google Scholar 

  37. Munshi I, Frim D, Stine-Reyes R, Weir BK, Hekmatpanah J, Brown F. Effects of posterior fossa decompression with and without duraplasty on Chiari malformation–associated hydromyelia. Neurosurgery. 2000;46:1384–9.

    Article  CAS  Google Scholar 

  38. Novegno F, Caldarelli M, Massa A, Chieffo D, Massimi L, Pettorini B, Tamburrini G, Di Rocco C. The natural history of the Chiari type I anomaly. J Neurosurg Pediatr. 2008;2:179–87.

    Article  Google Scholar 

  39. Pomeraniec IJ, Ksendzovsky A, Awad AJ, Fezeu F, Jane JA Jr. Natural and surgical history of Chiari malformation type I in the pediatric population. J Neurosurg Pediatr. 2016;7:343–52.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Paediatric Neurosurgery, Agostino Gemelli Hospital Foundation, Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Luca Massimi, Paolo Frassanito, Gianpiero Tamburrini & Massimo Caldarelli

  2. Paediatric Neuropsychology, Agostino Gemelli Hospital Foundation, Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Daniela Chieffo

Authors
  1. Luca Massimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Frassanito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Chieffo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianpiero Tamburrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Massimo Caldarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Massimi, L., Frassanito, P., Chieffo, D., Tamburrini, G., Caldarelli, M. (2019). Bony Decompression for Chiari Malformation Type I: Long-Term Follow-Up. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62515-7_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62514-0

  • Online ISBN: 978-3-319-62515-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation