MANAGEMENT OF ADULT CHIARI I RELATED SYRINGOMYELIA
Hussien Mohamed El-Maghraby;
Abstract
Background: Craniovertebral decompression is an established procedure to rectifY pressure differential across the craniovertebral junction. Despite the vast literature that exists about the different techniques of craniovertebral decompression, only a few prospective and ..comparative trails. have been worked out to assess the outcome of a particular technique/s.
Objective: The ann of this study is to evaluate •the short and long term outcome of the most widely performed techniques of craniovertebral decompression in the treatment of adult Chiari related syringomyelia.
Methods: In this prospective study, 75 adult patients were recruited during
1995-2000, and divided into 3 equal groups, where 3 different techniques of craniovertebral decompression were performed. Group I (CCVD) classic craniovertebral decompression involved bony decompression, dural and arachnoid opening, tonsillar amputation and hitching and exploration of the 41 ventricle without obex plugging. Group II (MCVD) modified craniovertebral decompression involved bony decompression, dural and arachnoid opening. Neither tonsillar amputation nor exploration of 4 the ventricle was performed. Group III (APCVD) arachnoid preserving craniovertebral decompression involved bony decompression, dural opening, and arachnoid was left intact All patients had preoperative & postoperative MRI, and 8 patients had preoperative & postoperative MRI CSF dynamic flow studies.
Results: Mortality was nil. Morbidity was 40% in group I (CCVD), 24% in group II (MCVD) and 4 % in group III (APCVD). Mean inpatient days were I 1.6, 10.2 and 4.9 days respectively. Mean convalescence in weeks were 8.9,
9.2 and 3.7 weeks respectively. Good postoperative radiological outcome was
80%, 84% and 92% respectively. Good postoperative clinical outcome and patients' questionnaire were 64%, 68% and 92% respectively. Predictors of good outcome include MRI findings of tonsillar herniation ::;; I0 mm and diminished caudal CSF flow at the foramen magnum, also craniovertebral decompression as the procedure of choice.
Conclusion: Craniovertebral decompression 1s a minimally mvas!Ve procedure capable to rectifY the aberrant" CSF flow across the craniovertebral junction in selected cases of Chiari related syringomyelia.
Objective: The ann of this study is to evaluate •the short and long term outcome of the most widely performed techniques of craniovertebral decompression in the treatment of adult Chiari related syringomyelia.
Methods: In this prospective study, 75 adult patients were recruited during
1995-2000, and divided into 3 equal groups, where 3 different techniques of craniovertebral decompression were performed. Group I (CCVD) classic craniovertebral decompression involved bony decompression, dural and arachnoid opening, tonsillar amputation and hitching and exploration of the 41 ventricle without obex plugging. Group II (MCVD) modified craniovertebral decompression involved bony decompression, dural and arachnoid opening. Neither tonsillar amputation nor exploration of 4 the ventricle was performed. Group III (APCVD) arachnoid preserving craniovertebral decompression involved bony decompression, dural opening, and arachnoid was left intact All patients had preoperative & postoperative MRI, and 8 patients had preoperative & postoperative MRI CSF dynamic flow studies.
Results: Mortality was nil. Morbidity was 40% in group I (CCVD), 24% in group II (MCVD) and 4 % in group III (APCVD). Mean inpatient days were I 1.6, 10.2 and 4.9 days respectively. Mean convalescence in weeks were 8.9,
9.2 and 3.7 weeks respectively. Good postoperative radiological outcome was
80%, 84% and 92% respectively. Good postoperative clinical outcome and patients' questionnaire were 64%, 68% and 92% respectively. Predictors of good outcome include MRI findings of tonsillar herniation ::;; I0 mm and diminished caudal CSF flow at the foramen magnum, also craniovertebral decompression as the procedure of choice.
Conclusion: Craniovertebral decompression 1s a minimally mvas!Ve procedure capable to rectifY the aberrant" CSF flow across the craniovertebral junction in selected cases of Chiari related syringomyelia.
Other data
| Title | MANAGEMENT OF ADULT CHIARI I RELATED SYRINGOMYELIA | Other Titles | معالجة مرض تجويف النخاع الشوكي | Authors | Hussien Mohamed El-Maghraby | Keywords | .Chiari-Syringomyelia -MRI CSF dynamic studies"Surgery Outcome | Issue Date | 2001 |
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