Craniovertebral junction anomalies are a group of diseases characterized by the pathological changes of occipital bone,atlantoaxial bone,cerebellar tonsil,surrounding soft tissue,and nervous system,which are caused by a variety of factors.Chiari malformation is a common type of craniovertebral junction anomalies,the conventional surgical therapy of which is posterior fossa decompression.Currently,scholars represented by Goel have proposed a new theory on the classification,pathogenesis,and treatment of Chiari malformation based on posterior atlantoaxial fixation (Goel technique).This article introduces the progress in Goel technique,aiming to provide reference for the clinical work.
Humans ; Arnold-Chiari Malformation/surgery*

Adult ; Arnold-Chiari Malformation ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the effectiveness and safety to treat Chiari malformation with the surgical decompression of the foramen magnum under endoscope.

METHODSIn 1 patient with Chiari malformation with syringomyelia, we made a 2.5 cm incision under the endoscope for the surgical decompression of the foramen magnum.

RESULTSAll the symptoms and signs were remarkably relieved, and the patient could walk the next day and was discharged 3 days after the operation.

CONCLUSIONThe endoscope-assisted decompression of the foramen magnum is a safe and effective surgical method to treat Chiari malformation.

Adult ; Arnold-Chiari Malformation ; complications ; surgery ; Decompression, Surgical ; methods ; Female ; Foramen Magnum ; surgery ; Humans ; Syringomyelia ; etiology ; surgery ; Treatment Outcome

OBJECTIVETo explore the surgical approaches, microsurgical techniques and therapeutic effect of modified cistern magna reconstruction for treating of syringomyelia with Chiari malformations.

METHODSThe clinical data of 35 patients with syringomyelia complicated by Chiari malformations were retrospectively reviewed, and the patients' chief complaints, presenting symptoms, neurological and radiographic findings, surgical approaches, outcomes, and complications were analyzed.

RESULTSThe radiographs revealed type I Chiari in 18 and type II Chiari malformations in these patients. Surgical treatment resulted in symptomatic improvements in 29 patients, and 6 patients showed no obvious changes in the symptoms after the surgery; 3 patients received subarachnoid shunting for syringomyelia. During the follow-up for a mean of 2 years, 32 patients showed obvious clinical improvement, and magnetic resonance imaging demonstrated complete spontaneous resolution of syringobulbia in 25 patients.

CONCLUSIONModified cistern magna reconstruction relieves brainstem compression and restores the pulsatile flow of the cerebrospinal fluid at the cervicomedullary junction. Cerebellar tonsil reduction is performed chiefly by electric coagulation and cauterization combined with subpial resection, and the integrity of the pia mater should be maintained as much as possible to avoid potential adhesion and recurrence. The median foramens and Luschka of the fourth ventricle have to be opened to recover normal CSF circulation. Arachnoidal suspension and placement of a patulous dural graft are also important. Modified reconstruction of the cistern magna can be a good option for treatment of syringomyelia complicated by Chiari malformations.

Adolescent ; Adult ; Arnold-Chiari Malformation ; complications ; surgery ; Cisterna Magna ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Syringomyelia ; complications ; surgery ; Young Adult

OBJECTIVESTo evaluate the changes of the position of medulla oblongata and cerebellum following posterior fossa decompression (PFD), and to investigate their influences on the prognosis of the syringomyelia in adolescents with Chiari malformation (CM).

METHODSA retrospective review was performed on all CM patients between September 2006 and September 2011. A subset of 46 patients, including 25 male and 21 female patients, was finally enrolled according to the inclusion criteria. The initial age and duration of follow-up averaged 13.9 years (range, 10-17 years) and 13 months (range, 6-52 months), respectively. On mid-sagittal MRI, the following parameters were evaluated pre- and postoperatively (follow-up ≥ 6 months): the longitudinal and transverse position of bulbopontine sulcus, the fourth ventricle vertex, the lower extreme of cerebella tonsil, the cervico-medullary angle, the maximal syrinx/cord(S/C) ratio and the syrinx length. Changes in these parameters were analysed using the paired samples t test, and for these reaching statistical significances, an additional bivariate correlation analysis was performed to investigate their relation with syrinx resolution.

RESULTSAt the latest follow-up, upward shifting of the bulbopontine sulcus was observed in 31 patients(67.4%), with upward shifting of the lower extreme of cerebella tonsil presenting in 35 patients(76.0%). The maximal S/C ratio and the syrinx length were significantly improved postoperatively (t = 7.114 and 7.816, P = 0.000).Significant resolution of the syrinx was demonstrated in 40 patients(86.9%), and more specifically, the average improvement rates of the maximal S/C ratio and the syrinx length were 32% ± 30%and 43% ± 33%, respectively. In addition, the bivariate correlation analysis revealed that syrinx resolution was significantly correlated with the upward shifting of the bulbopontine sulcus (r = 0.332, P = 0.027) and lower extreme of cerebella (r = 0.298, P = 0.044) .

CONCLUSIONThe upward shifting of the bulbopontine sulcus and the lower extreme of cerebella tonsil might be implicated in the mechanisms of postoperative syrinx resolution.

Adolescent ; Arnold-Chiari Malformation ; complications ; surgery ; Child ; Decompression, Surgical ; Female ; Humans ; Male ; Medulla Oblongata ; pathology ; Postoperative Period ; Retrospective Studies ; Syringomyelia ; complications ; surgery ; Treatment Outcome

OBJECTIVETo explore and evaluate the methodology of neuro-endoscope assisted atlanto occipital decompression in Chiari type I malformation with syringomyelia.

METHODSBetween January 2007 to January 2008, 8 patients underwent neuro-endoscope assisted atlanto occipital decompression, including 2 male patients and 6 female patients (aged 13 to 52 years). During the operations, the surgical fields were lightened by the illuminator of endoscope. All the manipulations were done outside the sheath of neuroendoscope. The decompression bone window was about 2.0 cm × 2.0 cm. After the atlanto occipital fascia was cleared thoroughly, dura were opened in 6 cases and intact in 2 cases.

RESULTSThere were no complications observed in this study. Seven patients were determined as excellent in recovery according to the Tator criteria because of apparent improvements in superficial sensation. Five of the seven patients had improvements in muscle strength. One patient was assessed as good because of stable symptom without deterioration.

CONCLUSIONNeuro-endoscope assisted atlanto occipital decompression is a potential technique worthy of employing in the mini-invasive neurosurgical technology.

Adolescent ; Adult ; Arnold-Chiari Malformation ; complications ; surgery ; Decompression, Surgical ; methods ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Syringomyelia ; complications ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo discuss the surgical treatment of chiari-I malformation complicated with syringomyelia.

METHODSThe surgical treatments of 247 cases were analyzed retrospectively. The indication of operation styles was proposed by various surgical treatment to different MRI (magnetic resonance imaging) findings. MRI findings includes: tonsillar herniation with no or slight syringomyelia (126 cases), tonsillar herniation with syringomyelia above C(2) (second cervical vertebrae) vertebral level (38 cases), serious tonsillar herniation (to C(2) approximately C(3) level) with syringomyelia of isolated spinal segments (67 cases), serious tonsillar herniation (to C(2) approximately C(3) level) with syringomyelia above C(2) vertebral level (16 cases). They were performed by posterior fossa decompression, posterior fossa decompression and incision of the syringomyelia, posterior fossa decompression and resection of the cerebellar tonsils, posterior fossa decompression and incision of the syringomyelia combined with resection of the cerebellar tonsils respectively.

RESULTSThe clinical signs and symptoms had been markedly improved or improved in 197 cases (79.8%) until patients were discharged from hospital, unchanged in 39 cases (15.8%), deteriorated in 7 cases (2.8%). there were 4 death in all cases after surgery. 107 cases were followed up from 5 months to 9 years. The postoperative MRI findings in the 107 patients demonstrated that the cavities in spinal cords disappeared completely or nearly in 78 cases, reduced in 14 cases, unchanged in 15 cases.

CONCLUSIONSPosterior fossa decompression, posterior fossa decompression and incision of the syringomyelia, posterior fossa decompression and resection of the cerebellar tonsils, posterior fossa decompression and incision of the syringomyelia combined with resection of the cerebellar tonsils should be an effective method for treatment of chiari-I malformation complicated with syringomyelia. Surgical treatment may fully ameliorate the clinical syndromes.

Adolescent ; Adult ; Aged ; Arnold-Chiari Malformation ; complications ; surgery ; Child ; Craniotomy ; Female ; Humans ; Laminectomy ; Male ; Middle Aged ; Retrospective Studies ; Syringomyelia ; complications ; surgery

BACKGROUNDIn order to make posterior fossa decompression for the management of Chiari I malformation simple and less invasive while using direct visualization, a novel solely endoscopic procedure has been employed for the decompression of Chiari malformation type I. The objective of this study was to present neural endoscopic posterior fossa decompression and atlas laminectomy for Chiari type I patients.

METHODSTwenty-one patients with Chiari type I underwent neural endoscopic posterior fossa decompression and atlas laminectomy. We described the procedure for neural endoscopic posterior fossa decompression and atlas laminectomy. All patients in this series demonstrated cerebellar tonsil herniation below the foramen magnum in addition to syringomyelia. All patients in the reviewed study underwent preoperative MRI as well as 3-month postoperative MRI. Additional follow-up MRI varied but was usually repeated 12 months to 18 months after surgery. Postoperative MRI studies were retrospectively reviewed and compared with preoperative studies.

RESULTSAll patients showed clinical improvements, and none had any complications. Patients with syringomyelia had symptoms entirely disappear. Eleven patients (52.4%) experienced radiographic improvement in syringomyelia (decreased size or resolution) during the follow-up period. Nine patients (42.8%) demonstrated decreased syrinx size and four (19%) demonstrated resolved syrinx. Of the 15 patients with symptomatic syringomyelia, 11 (73.3%) experienced symptomatic improvement. The median time to symptom improvement was four months after surgery. Post surgical MRI examinations indicated complete and sufficient decompression of foramen magnum region.

CONCLUSIONSEndoscope atlanto-occipital decompression surgery is an innovative, safe and effective surgical procedure. It has similar results compared to traditional surgery, however with the added advantages of being minimal invasive, having fewer complications, decreased influence on stability of occipital bony structure, and a faster recovery as well as reduced hospital stay and expenses.

Adolescent ; Arnold-Chiari Malformation ; surgery ; Child ; Decompression, Surgical ; methods ; Endoscopy ; methods ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Minimally Invasive Surgical Procedures ; methods ; Retrospective Studies ; Syringomyelia ; surgery