gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Experience with 212 Chiari-I/II and 33 other foraminal malformations – An algorithm for tailored craniocervical decompressions

Erfahrungen mit 212 Chiari-I/II- und 33 anderen foraminalen Malformationen. Kraniozervikale Dekompressionen nach Maß

Meeting Abstract

  • corresponding author K. Geletneky - Neurochirurgische Universitätsklinik, Universitätsklinikum Heidelberg
  • B. Orakcioglu - Neurochirurgische Universitätsklinik, Universitätsklinikum Heidelberg
  • D. Haux - Neurochirurgische Universitätsklinik, Universitätsklinikum Heidelberg
  • S. Muhcu - Neurochirurgische Universitätsklinik, Universitätsklinikum Heidelberg
  • R. Wirtz - Neurochirurgische Universitätsklinik, Universitätsklinikum Heidelberg
  • A. Aschoff - Neurochirurgische Universitätsklinik, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMI.04.01

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc227.shtml

Published: May 30, 2008

© 2008 Geletneky et al.
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Outline

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Objective: The basic principle of restoration of craniocervical CSF flow by decompressions is wideley accepted. However, there are numerous variations of the technique.

Methods: Since 1970 we registered 153 Chiari-I, 67-Chiari-II-malformations, 17 basilar impressions and 16 other foraminal pathologies.

170 patients had 205 operations. In nearly all cases craniocervical decompressions were performed with regular duraplasties, preferring biological materials such as the occipital galea-periost. Initially we routinely opened the arachnoid membrane, in the last years only in cases with visible adhesions, a non-transparent arachnoid membrane or missing pulsations after opening of the dura (ca. 30%). The tonsils were not resected except for two massive cases. Sometimes we perform lateral coagulations of the pia mater of the tonsils.

Results: The Chiari-1-patients with/without hydromyelia showed full remission in 11.3%/ 11.8%. 35.6%/ 52.9% improved and 38.3%/29.4% could be stabilized. In 13.9%/5.9% we observed deteriorations. One patient is in a very poor condition. There was no op-associated mortality. However, two patients died while waiting for the operation, one with massive sleep apnoe due to home respirator problems.

Conclusions: The simplified therapy with the rare opening of the arachnoid membrane and no manipulations of the tonsils reduced the complications, which were associated with a major loss of CSF or pneumatocephalus. 9/10 showed a favourable outcome.