gms | German Medical Science

Objective: Chiari malformations during childhood represent an interdisciplinary challenge. Whereas Chiari I malformation can remain clinically mute for quite some time, Chiari II malformations mightpresentwith a much more acute scenario, sometimes requiring prompt surgical intervention.Many centers of pediatricneurosurgery rely alone on intraoperative ultrasound for posterior fossa decompression.

Methods: From 8/2009 until present we operated on n=17 children harboring Chiari Typ I & Typ II (n=7). Theyoungest patient was around 5 months old, the oldest was 14 years. N=3 (Chiari I) were treated bythird ventricluostomy endoscopy (ETV) successfully alone. Children with Chiari IIwere operated via ultrasound guided decompression of the posterior fossawithout dural opening, incl. C1 laminectomy. All children showed a freedcerebrospinal liquid passage. The dura was left untouched in all patients.

Results: All Chiari II kids withbad prognosticators like bilateral vocal cord paresis lost their tracheal canula whithin 4 weeksafter surgery and were on spontaneously breathing pattern. In addition cerebellarsymptoms improved as well. The grading of cerebellar herniation was not significant forsurgical technique or postoperative outcome.

Conclusion: Chiari malformations require a case adapted therapy at the right time. Postoperative results of theChiari II group clearly indicate the importance of ultrasound during surgery combined with anintraoperative "step by step" strategy. They encourage ultrasound guided decompression of theposterior fossa, leaving the pediatric dura when possible intact.