Resolution of Syringomyelia After Posterior Fossa Decompression with and Without Duraplasty in Chiari Malformation-1

Authors

  • Syed Nasir Shah Mardan Medical Complex, Mardan
  • Muhammad Ishaq Mardan Medical Complex, Mardan
  • Musawer Khan Mardan Medical Complex, Mardan
  • Gohar Ali Mardan Medical Complex, Mardan
  • Muhammad Idris Khan Mardan Medical Complex, Mardan
  • Sohail Amir Hayatabad Medical Complex, Peshawar

DOI:

https://doi.org/10.36283/PJMD13-3/009

Keywords:

Chairi malformation, duraplasty, posterior fossa decompression, spinal cord, syringomyelia

Abstract

Background: Chiari malformations (CMs) encompass a range of clinicopathological conditions that exhibit diverse etiology, pathophysiology, and clinical characteristics. This study was done to compare the resolution of syringomyelia after posterior fossa decompression with and without duraplasty in Chiari malformation-1 (CM-1).

Methods: This Quasi-experimental study was conducted at the Department of Neurosurgery, Mardan Medical Complex, Mardan, from January to November 2023. A non-probability, consecutive sampling technique was adopted. Thirty-two children of either gender, aged below 16 years, presenting with CM-1, and planned to undergo either posterior fossa decompression with duraplasty (PFDD) or posterior fossa decompression without duraplasty (PFD) were analyzed. Duration of procedure (minutes) estimated intra-operative blood loss (ml) and post-surgical complications were noted. Outcomes in terms of resolution or improvement in syringomyelia along with syrinx diameter were compared after 6 months. Qualitative variables were compared using chi-square or Fisher's exact test, and quantitative variables were assessed using independent sample t-tests with p<0.05 considered significant.

Results: Out of 32 children analyzed, 18(56.3%) were boys while the mean age was 11.4±4.2 years. There were 18(56.3%) patients who underwent PFDD while the remaining 14(47.7%) had PFD performed. Syringomyelia resolution (88.9% vs. 92.9%, p=0.7024) were relatively similar. Duration of surgery (2.4±0.7 hours vs. 3.6±1.4 hours, p=0.0035) and hospitalization (29.5±8.5 hours vs. 40.5±9.4, p=0.0018) were significantly less among children who underwent PFD when compared to PFDD.

Conclusion: Foramen magnum decompression with and without duraplasty in Chiari malformation-1 showed similar clinical outcomes and both were effective in reducing the syrinx size associated with syringomyelia.

Keywords: Etiology, Foramen Magnum, Hospitalization, Spinal Cord, Syringomyelia.

Author Biographies

  • Syed Nasir Shah, Mardan Medical Complex, Mardan

    Neurosurgery Department

  • Muhammad Ishaq, Mardan Medical Complex, Mardan

    Neurosurgery Department

  • Musawer Khan, Mardan Medical Complex, Mardan

    Neurosurgery Department

  • Gohar Ali, Mardan Medical Complex, Mardan

    Neurosurgery Department 

  • Muhammad Idris Khan, Mardan Medical Complex, Mardan

    Neurosurgery Department 

  • Sohail Amir, Hayatabad Medical Complex, Peshawar

    Department of Neurosurgery

References

Spazzapan P, Bosnjak R, Prestor B, Velnar T. Chiari malformations in children: An overview. World J Clin Cases. 2021;9(4):764-773. doi:10.12998/wjcc.v9.i4.764

Loukas M, Noordeh N, Shoja MM, Pugh J, Oakes WJ, Tubbs RS. Hans Chiari (1851-1916). Childs Nerv Syst. 2008;24(3):407-409. doi:10.1007/s00381-007-0535-y

Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging. J Neurosurg Pediatr. 2011;8(2):205-213. doi:10.3171/2011.5.PEDS1121

Pan KS, Heiss JD, Brown SM, Collins MT, Boyce AM. Chiari I Malformation and Basilar Invagination in Fibrous Dysplasia: Prevalence, Mechanisms, and Clinical Implications. J Bone Miner Res. 2018;33(11):1990-1998. doi:10.1002/jbmr.3531

Liu Z, Hao Z, Hu S, Zhao Y, Li M. Predictive value of posterior cranial fossa morphology in the decompression of Chiari malformation type I: A retrospective observational study. Medicine (Baltimore). 2019;98(19):e15533. doi:10.1097/MD.0000000000015533

Liu H, Yang C, Yang J, Xu Y. Pediatric Chiari malformation type I: long-term outcomes following small-bone-window posterior fossa decompression with autologous-fascia duraplasty. Exp Ther Med. 2017;14(6):5652-5658. doi:10.3892/etm.2017.5211

Hidalgo ET, Dastagirzada Y, Orillac C, Kvint S, North E, Bledea R, et al. Time to Resolution of Symptoms After Suboccipital Decompression with Duraplasty in Children with Chiari Malformation Type I. World Neurosurg. 2018;117:e544-e551. doi:10.1016/j.wneu.2018.06.073

Lu C, Ma L, Yuan C, Cheng L, Wang X, Duan W, et al. Phenotypes and prognostic factors of Syringomyelia in Single-Center Patients sith Chiari I Malformation: Moniliform Type as a Special Configuration. Neurospine. 2022;19(3):816-827. doi:10.14245/ns.2244332.166

Gallo E, Rahmathulla G, Rao D, Tavanaiepour K, Tavanaiepour D. Spontaneous syrinx resolution in patient with Chiari I malformation: illustrative case. J Neurosurg Case Lessons. 2021;1(26):CASE21236. doi:10.3171/CASE21236

Van Der Veken J, Harding M, Hatami S, Agzarian M, Vrodos N. Syringomyelia intermittens: highlighting the complex pathophysiology of syringomyelia. Illustrative case. J Neurosurg Case Lessons. 2021;2(11):CASE21341. doi:10.3171/CASE21341

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(8):1419-1424. doi:10.1007/s00381-014-2424-5

Ventureyra EC, Aziz HA, Vassilyadi M. The role of cine flow MRI in children with Chiari I malformation. Childs Nerv Syst. 2003;19:109–113.

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;46:1384–1389. discussion 1389–1390.

McGirt MJ, Attenello FJ, Atiba A, Garces-Ambrossi G, Datoo G, Weingart JD, Carson B, Jallo GI. Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases. Childs Nerv Syst. 2008;24:1333–1339.

Limonadi FM, Selden NR. Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. J Neurosurg. 2004;101:184–188.

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;20:349–356.

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;2:42–49.

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;105:26–32.

Ventureyra EC, Aziz HA, Vassilyadi M. The role of cine flow MRI in children with Chiari I malformation. Childs Nerv Syst. 2003;19:109–113.

Fuentes AM, Chiu RG, Nie J, Mehta AI. Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I. Clin Neurol Neurosurg. 2021;207:106757. doi:10.1016/j.clineuro.2021.106757

Jiang E, Sha S, Yuan X, Zhu W, Jiang J, Ni H, et al. Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression with and without Duraplasty for Treatment of Pediatric Chiari I Malformation: A Prospective Study. World Neurosurg. 2018;110:e465-e472. doi:10.1016/j.wneu.2017.11.007

Rosenblum JS, Pomeraniec IJ, Heiss JD. Chiari Malformation (Update on Diagnosis and Treatment). Neurol Clin. 2022;40(2):297-307. doi: 10.1016/j.ncl.2021.11.007

Tanaka M, Sharma S, Fujiwara Y, Arataki S, Omori T, Kanamaru A, et al. Accurate Posterior Fossa Decompression Technique for Chiari Malformation Type I and a Syringomyelia With Navigation: A Technical Note. Int J Spine Surg. 2023;17(4):615-622. doi: 10.14444/8483

Talamonti G, Picano M, Fragale M, Marcati E, Meccariello G, Boeris D, Cenzato M. Reoperation in Chiari-1 Malformations. J Clin Med. 2023;12(8):2853. doi: 10.3390/jcm12082853

Talamonti G, Ferrari E, D'Aliberti G. Chiari malformation type 1: are we doing less with more? Illustrative case. J Neurosurg Case Lessons. 2021;1(6):CASE20145. doi: 10.3171/CASE20145

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Published

2024-08-01

How to Cite

1.
Shah SN, Ishaq M, Khan M, Ali G, Khan MI, Amir S. Resolution of Syringomyelia After Posterior Fossa Decompression with and Without Duraplasty in Chiari Malformation-1. PJMD [Internet]. 2024 Aug. 1 [cited 2024 Oct. 6];13(3):60-5. Available from: https://ojs.zu.edu.pk/pjmd/article/view/2634

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