Article
Long-term results in syringomyelia with Chiari type I malformation. A mixed retrospective and prospective single-institution cohort study
Search Medline for
Authors
-
A. Alfieri
- Klinik für Neurochirurgie, Martin Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
-
G. Pinna
- Department of Neurosurgery, University Hospital. Verona, Italy
| Published: | June 4, 2012 |
|---|
Outline
Text
Objective: To evaluate the long-term effectiveness and the complications following decompressive surgery for Chiari malformation type I- (CM-I) related syringomyelia.
Methods: A mixed retrospective and prospective single-institution cohort of 109 consecutive surgically treated adult patients with syringomyelia and CM-I was studied with long-term clinical and radiological follow-up. All patients underwent a standardized surgical protocol: decompression of the craniocervical junction, arachnoid exploration and shrinkage of the cerebellar tonsils. Factors predicting outcome were investigated.
Results: The retrospective arm consisted of 41 cases between 1990 and 1994, and the prospective study followed 68 patients from 1994 to 2001. The mean age was 45.9, and 58.8% were female. The median follow-up was 12.7 years. The most frequent initial symptoms were pain and sensory and gait disturbances. There was no perioperative mortality or neurological deterioration. The comprehensive perioperative complication rate was approximately 11%, with three cases (2.7%) of CSF leakage. Significant correlations between age at time of surgery, disease duration, recovery rate and radiological findings were demonstrated. Clinical follow-up confirmed surgical result stability with clinical amelioration of > 90% of the spinal and cranial manifestations over a long-term period. Two cases had radiological recurrences of syringomyelia without clinical signs 85 and 124 months after surgery.
Conclusions: Certain clinical predictors of poor clinical and radiological prognosis were identified, namely age at time of surgery and symptom duration. The results of this study provide additional long-term data that support the effectiveness and safety of relieving a CSF block at the craniocervical junction in CM-I related syringomyelia.
