Download PDF
J Neurol Surg B Skull Base 2024; 85(02): 202-211
DOI: 10.1055/a-2127-0094
Orginal Article

Neuroendoscopy-Assisted Minimal Invasive Management of Chiari 1 Malformation

Göksal Günerhan
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Emin Çağıl
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Zeynep Dağlar
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Uğur Kemal Gündüz
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Ali Dalgıç
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
,
Ahmet Deniz Belen
1   Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective The aim this study is to present the results of the minimal invasive neuroendoscopic-assisted system application as an alternative to traditional surgery in patients with Chiari malformation type 1 (CM type 1) with/without syringomyelia.

Design, Setting, and Participants In the study, data of 22 symptomatic patients were prospectively collected. Before and after the operation, patient characteristics, computed tomography, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow dynamics MRI, and outcome scales scores were recorded. Foramen magnum decompression and C1 total laminectomy were performed. The fibrous band at the craniocervical junction was opened and a durotomy was performed. In patients with a syrinx, the pre- and postoperative axial and sagittal lengths of the syrinx were measured and compared.

Results The mean age of the patients was 32 ± 5 years. There were eight male patients. Ten patients had syrinx. The mean visual analog scale (VAS) score before and after surgery was 8 ± 1.06 and 2.18 ± 1.13, respectively. When evaluated according to the Chicago Chiari Outcome Scale, there was improvement in 20 patients, while there was no change in 2 patients. Syrinx resolved completely in 3 of 10 (13.6%) patients with syringomyelia, and the syrinx volume decreased in 3 patients (13.6%). In 4 of 10 (18.1%) patients, there was no significant change in the syrinx volume. The average operation time was 105 minutes (80–150 minutes). The average blood loss was 40 mL (20–110 mL).

Conclusion Although the study was limited due to the small number of patients with a short follow-up, endoscopic decompression was a safe and effective technique for surgery in CM type 1 patients.

Keywords

neuroendoscopy - Chiari malformation - minimally invasive surgical procedures - syringomyelia - posterior fossa decompression

Ethical Approval

This study was approved by the Institutional Review Board (TUEK E1–22–2615), and written informed consent was obtained from each patient.


Authors' Contributions

Conceptualization was done by G.G. and E.Ç.. Investigation was done by G.G., E.Ç., and Z.D.. Project administration was done by ADB and AD. GG, AD, and UKG were responsible for the resources. Surgery was performed by GG. Writing of the original draft was done E.Ç., Z.D., and U.K.G.. G.G., A.D., A.D.B. contributed to the writing, review, and editing of the manuscript.




Publication History

Received: 02 April 2023

Accepted: 08 July 2023

Accepted Manuscript online:
11 July 2023

Article published online:
11 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Nishikawa M, Bolognese PA, Kula RW, Ikuno H, Ohata K. Pathogenesis and classification of Chiari malformation type I based on the mechanism of ptosis of the brain stem and cerebellum: a morphometric study of the posterior cranial fossa and craniovertebral junction. J Neurol Surg B Skull Base 2021; 82 (03) 277-284
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Mobbs R, Teo C. Endoscopic assisted posterior fossa decompression. J Clin Neurosci 2001; 8 (04) 343-344
    CrossrefPubMedGoogle Scholar
  • 3 Ratre S, Yadav N, Yadav YR, Parihar VS, Bajaj J, Kher Y. Endoscopic management of Arnold-Chiari malformation type I with or without syringomyelia. J Neurol Surg A Cent Eur Neurosurg 2018; 79 (01) 45-51
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Di X. Endoscopic suboccipital decompression on pediatric Chiari type I. Minim Invasive Neurosurg 2009; 52 (03) 119-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Holly LT, Batzdorf U. Management of cerebellar ptosis following craniovertebral decompression for Chiari I malformation. J Neurosurg 2001; 94 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 6 Deng K, Li YN, Li GL. et al. Neural endoscopic assisted micro-invasive management of Chiari I malformation. Chin Med J (Engl) 2010; 123 (14) 1878-1883
    PubMedGoogle Scholar
  • 7 Milhorat TH, Chou MW, Trinidad EM. et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 1999; 44 (05) 1005-1017
    CrossrefPubMedGoogle Scholar
  • 8 Aliaga L, Hekman KE, Yassari R. et al. A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery 2012; 70 (03) 656-664 , discussion 664–665
    CrossrefPubMedGoogle Scholar
  • 9 Yamada S. Cerebrospinal fluid dynamics. Croat Med J 2021; 62 (04) 399-410
    CrossrefPubMedGoogle Scholar
  • 10 Marshman LAG, Benjamin JC, Chawda SJ, David KM. Acute obstructive hydrocephalus associated with infratentorial subdural hygromas complicating Chiari malformation type I decompression. Report of two cases and literature review. J Neurosurg 2005; 103 (04) 752-755
    CrossrefPubMedGoogle Scholar
  • 11 Park JK, Gleason PL, Madsen JR, Goumnerova LC, Scott RM. Presentation and management of Chiari I malformation in children. Pediatr Neurosurg 1997; 26 (04) 190-196
    CrossrefPubMedGoogle Scholar
  • 12 Krieger MD, McComb JG, Levy ML. Toward a simpler surgical management of Chiari I malformation in a pediatric population. Pediatr Neurosurg 1999; 30 (03) 113-121
    CrossrefPubMedGoogle Scholar
  • 13 Bisht M, Kumar A, Singh PK. et al. Evaluation of dural parameters at C1 level in patients with Chiari 1 malformation following foramen magnum and C1 posterior arch removal: introduction of a novel concept to decompress without affecting stability. Neurol India 2022; 70 (Supplement): S160-S165
    CrossrefPubMedGoogle Scholar
  • 14 Mugge L, Caras A, Henkel N, Dassi C, Schroeder J, Prevedello DM. Headache and other symptoms in Chiari malformation type I are associated with cerebrospinal fluid flow improvement after decompression: a two-institutional study. World Neurosurg 2022; 163: e253-e262
    CrossrefPubMedGoogle Scholar
  • 15 Yadav YR, Parihar V, Namdev H, Agarwal M, Bhatele PR. Endoscopic interlaminar management of lumbar disc disease. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (02) 77-81
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Yadav YR, Parihar VS, Ratre S, Kher Y. Avoiding complications in endoscopic third ventriculostomy. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (06) 483-494
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Caffo M, Cardali SM, Caruso G. et al. Minimally invasive posterior fossa decompression with duraplasty in Chiari malformation type I with and without syringomyelia. Surg Neurol Int 2019; 10: 88
    CrossrefPubMedGoogle Scholar
  • 18 Logue V, Edwards MR. Syringomyelia and its surgical treatment: an analysis of 75 patients. J Neurol Neurosurg Psychiatry 1981; 44 (04) 273-284
    CrossrefPubMedGoogle Scholar