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Factors contributing improvement of syringomyelia and surgical outcome in type I Chiari malformation

Authors
 Young Seok Park  ;  Dong-Seok Kim  ;  Kyu-Won Shim  ;  Jung-Hee Kim  ;  Joong-Uhn Choi 
Citation
 CHILDS NERVOUS SYSTEM, Vol.25(4) : 453-459, 2009 
Journal Title
CHILDS NERVOUS SYSTEM
ISSN
 0256-7040 
Issue Date
2009
MeSH
Adolescent ; Adult ; Analysis of Variance ; Arnold-Chiari Malformation/complications ; Arnold-Chiari Malformation/surgery* ; Cerebellum/surgery* ; Child ; Child, Preschool ; Cranial Fossa, Posterior/surgery* ; Craniotomy ; Decompression, Surgical* ; Female ; Head/pathology ; Head/surgery ; Humans ; Infant ; Linear Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Syringomyelia/etiology ; Syringomyelia/surgery* ; Treatment Outcome ; Young Adult
Keywords
Chiari malformation ; Syringomyelia ; Suboccipital decompression ; Shunt ; Posterior fossa
Abstract
OBJECTIVE: The aim of our study was to compare pre- and postoperative radiologic data of posterior fossa and the improvement of syringomyelia after posterior fossa decompression (PFD) with and without tonsillar management in Chiari type capital I, Ukrainian malformation (CM-I).

MATERIAL AND METHODS: A retrospective analysis was made of all patients who underwent PFD between Oct 1991 and March 2007 for CM-I. Fifty-seven patients treated for CM-I at a single institution were included in the study. Patients were divided into two groups according to the procedures used during their PFD: PFD vs. PFD with tonsillar management. To determine whether the tonsillar management or changes of posterior fossa volume relate with surgical outcome, we measure posterior fossa size and syringomyelia pre- and postoperatively using magnetic resonance imaging.

RESULTS: Forty patients (70.2%) received PFD and 17 patients (29.8%) received PFD with tonsillar management. The length of syringomyelia affected improvement of syringomyelia (alteration rate, A-rate). Clinical symptoms, craniectomy size, syringomyelia type, and the surgeon's specialty did not affect A-rate. Tonsillar management has no significant effect on improvement of syringomyelia. Four patients need repeated surgery due to recurrence.

CONCLUSION: We have shown that tonsillar management do not lead to improve A-rate, and the radiologic changes of posterior fossa volume do not relate with radiologic improvement of syringomyelia. PFD without tonsillar management is sufficient to improve syringomyelia. The longer syrinx, the more A-rate improve in our study. However, a wider craniectomy is unrelated to A-rate. In cases of recurrent patients, we obtained good results with tonsillar management or syringosubarachnoid shunt.
Full Text
http://link.springer.com/article/10.1007%2Fs00381-008-0763-9
DOI
10.1007/s00381-008-0763-9
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Seok(김동석)
Kim, Jung Hee(김정희)
Park, Young Seok(박영석)
Shim, Kyu Won(심규원) ORCID logo https://orcid.org/0000-0002-9441-7354
Choi, Joong Uhn(최중언)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/104191
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