Dura splitting decompression in Chiari type 1 malf

Authors: Dorian Chauvet Alexandre Carpentier Bernard George

Publish Date: 2009/07/31

Volume: 32, Issue: 4, Pages: 465-470

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Abstract

To restore the cerebrospinal fluid CSF flow at the craniocervical junction in Chiari I malformation CMI most surgeons practice a suboccipital craniectomy with duraplasty To reduce the risk of CSF leak a dura splitting decompression is created removing only the dural outer layer We report on a series of 11 patients with CMI five with syringomyelia operated on between 2000 and 2007 using this technique Neurological examination and cerebrospinal MRI scan were performed before and after surgery Symptoms improved completely in six patients Headaches and cervicalgias disappeared for all patients Dizziness and paresthesia in the upper limb remained unchanged for three and two patients respectively We observed no complications such as CSF leak meningocele or meningitis Postoperative MRI scan showed a significant craniocervical decompression in ten patients Four patients had a new cisterna magna Two syringomyelias completely disappeared two decreased and one was stable Dural splitting can be practiced to treat CMI Clinical results are similar to the other techniques with less complications Radiological findings show satisfying posterior fossa decompressionMagnetic resonance imaging has revolutionized the management of Chiari malformation increasing the possibility of diagnosis and enhancing the control of treatment The restoration of fluid flow in craniovertebral junction reappearance of cisterna magna with narrowing of syringomyelia cavities and relief of compression of posterior fossa structures assures the adequacy of the treatment on a less empirical basis than in the era preMRIThe techniques for decompression of the posterior fossa have been directed to those with greatest possibilities of success and fewer rates of complications As the small volume of the cranial fossa is the common physiopathological factor in MC the bone decompression of the posterior fossa would be the first aimed step in the surgical treatment The dural decompression opening of the arachnoid layer and internal decompression of the cerebellar tonsils has been reassessed in the era postresonance leading to a search for more minimally invasive surgeries for these malformations The authors Chauvet Carpentier and George has described and illustrated a sample of patients adequately decompressed by resection of occipital bone and outer layer of the dura mater with documentation of syringomyelia narrowing and enlargement of cisterna magna with minimal surgical morbidity

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