Article
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
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Published: | May 30, 2008 |
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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.