J Neurol Surg A Cent Eur Neurosurg 2018; 79(01): 045-051
DOI: 10.1055/s-0036-1594011
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Management of Arnold-Chiari Malformation Type I with or without Syringomyelia

Shailendra Ratre
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Nishtha Yadav
2   Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, New Delhi, India
,
Yad Ram Yadav
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Vijay Singh Parihar
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Jitin Bajaj
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Yatin Kher
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
› Author Affiliations
Further Information

Publication History

01 January 2016

14 September 2016

Publication Date:
06 June 2017 (online)

Abstract

Introduction Several different surgical techniques have been used in the treatment of patients with symptomatic Arnold-Chiari malformation type 1 (ACM-1) with or without syrinx. Endoscope-assisted decompression of the posterior fossa has been found to be safe and effective. We report our initial experience of endoscopic management of ACM-I.

Material and Methods This was a prospective study of 15 symptomatic patients. Pre- and postoperative clinical status and computed tomography and magnetic resonance imaging findings were recorded. Suboccipital bone of ∼ 3 cm distance from the foramen of magnum and posterior arch of atlas was removed. Partial splitting of the dura mater with preservation of the inner portion and the arachnoid membrane was performed. Any change in axial and sagittal length of the syrinx, tonsillar ascension, shape of the tonsil tip, appearance of cerebrospinal fluid posterior to the tonsil, and formation of the cisterna magna were recorded. Patients with atlantoaxial instability, tethered cord, associated myelomeningocele, hydrocephalus, or elevated intracranial pressure were excluded.

Results Age of patients ranged from 26 to 48 years. There were nine female patients. There were six patients with ACM-I without and nine with ACM-I with syrinx. Average pre- and postoperative Karnofsky performance score was 78 and 93, respectively. Average operative time was 130 minutes (110–190 minutes), and blood loss was 30 mL (20–180 mL). Follow-up ranged from 9 to 21 months.

Conclusion Although the study is limited by the small number of patients with a short follow-up, endoscopic decompression in selected patients of ACM-I with or without syrinx with dural splitting was a safe and effective alternative to microsurgical treatment.

 
  • References

  • 1 Mobbs R, Teo C. Endoscopic assisted posterior fossa decompression. J Clin Neurosci 2001; 8 (04) 343-344
  • 2 Di X. Endoscopic suboccipital decompression on pediatric Chiari type I. Minim Invasive Neurosurg 2009; 52 (03) 119-125
  • 3 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
  • 4 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
  • 5 Nomura K, Yoshida M, Kawai M, Okada M, Nakao S. A novel microendoscopically assisted approach for the treatment of recurrent lumbar disc herniation: transosseous discectomy surgery. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (03) 183-188
  • 6 Yadav YR, Madhariya SN, Parihar VS, Namdev H, Bhatele PR. Endoscopic transoral excision of odontoid process in irreducible atlantoaxial dislocation: our experience of 34 patients. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (03) 162-167
  • 7 Tabaee A, Kamat A, Shrivastava R. Complex reconstruction of the sella using absorbable mini-plate in revision endoscopic pituitary surgery: technical note. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (05) 313-317
  • 8 Iannelli A, Lenzi R, Muscatello L. A useful maneuver to simplify sellar floor repair following endoscopic transnasal pituitary surgery. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (02) 158-160
  • 9 Duque SG, Gorrepati R, Kesavabhotla K, Huang C, Boockvar JA. Endoscopic endonasal transsphenoidal surgery using the BrainLAB® Headband for navigation without rigid fixation. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (04) 267-269
  • 10 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
  • 11 Setty P, D'Andrea KP, Stucken EZ, Babu S, LaRouere MJ, Pieper DR. Fully endoscopic resection of cerebellopontine angle meningiomas. J Neurol Surg A Cent Eur Neurosurg 2016; 77 (01) 11-18
  • 12 Herrada-Pineda T, Revilla-Pacheco F, Manrique-Guzman S. Endoscopic approach for the treatment of pineal region tumors. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (01) 8-12
  • 13 Raju S, Sharma RS, Moningi S, Momin J. Neuroendoscopy for intracranial arachnoid cysts in infants: therapeutic considerations. J Neurol Surg A Cent Eur Neurosurg 2016; 77 (04) 333-343
  • 14 Banczerowski P, Czigléczki G, Gádor I. , et al. Long-term outcome of endonasal transsphenoidal approach for the treatment of pontine cavernous malformation: case report with 11 years of follow-up. J Neurol Surg A Cent Eur Neurosurg 2016; 77 (03) 269-273
  • 15 Ochalski P, Chivukula S, Shin S, Prevedello D, Engh J. Outcomes after endoscopic port surgery for spontaneous intracerebral hematomas. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (03) 195-205 ; discussion 206
  • 16 Nakatogawa H, Tanaka T, Inenaga C, Fujimoto A, Yamamoto T. Endoscopic removal of neonatal acute epidural hematoma via strip-bending osteoplastic craniotomy. Technical note. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (06) 495-498
  • 17 Ueba T, Yasuda M, Inoue T. Endoscopic burr hole surgery with a curettage and suction technique to treat traumatic subacute subdural hematomas. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (01) 63-65
  • 18 Yadav YR, Parihar V, Pande S, Namdev H. Endoscopic management of colloid cysts. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (05) 376-380
  • 19 Ratre S, Yadav YR, Parihar VS, Kher Y. Micro-endoscopic removal of deep-seated brain tumors using tubular retraction system. J Neurol Surg A Cent Eur Neurosurg 2016; 77 (04) 312-320
  • 20 Hu Z, Guan F, Kang T. , et al. Whole course neuroendoscopic resection of cerebellopontine angle epidermoid cysts. J Neurol Surg A Cent Eur Neurosurg 6; 77 (05) 381-388
  • 21 Yadav YR, Sinha M, Parihar V. ; Neha. Endoscopic management of brain abscesses. Neurol India 2008; 56 (01) 13-16
  • 22 Yadav YR, Parihar V, Agrawal M, Bhatele PR. Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus. Neurol India 2011; 59 (06) 855-860
  • 23 Xie D, Qiu Y, Sha S. , et al. Syrinx resolution is correlated with the upward shifting of cerebellar tonsil following posterior fossa decompression in pediatric patients with Chiari malformation type I. Eur Spine J 2015; 24 (01) 155-161
  • 24 Nagoshi N, Iwanami A, Toyama Y, Nakamura M. Factors contributing to improvement of syringomyelia after foramen magnum decompression for Chiari type I malformation. J Orthop Sci 2014; 19 (03) 418-423
  • 25 Lee HS, Lee SH, Kim ES. , et al. Surgical results of arachnoid-preserving posterior fossa decompression for Chiari I malformation with associated syringomyelia. J Clin Neurosci 2012; 19 (04) 557-560
  • 26 Genitori L, Peretta P, Nurisso C, Macinante L, Mussa F. Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases. Childs Nerv Syst 2000; 16 (10–11): 707-718
  • 27 Litvack ZN, Lindsay RA, Selden NR. Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization. Neurosurgery 2013; 72 (06) 922-928 ; discussion 928–929
  • 28 Kennedy BC, Kelly KM, Phan MQ. , et al. Outcomes after suboccipital decompression without dural opening in children with Chiari malformation type I. J Neurosurg Pediatr 2015; 16 (02) 150-158
  • 29 Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD. Comparison of posterior fossa decompression with or without duraplasty in children with type I Chiari malformation. Childs Nerv Syst 2014; 30 (08) 1419-1424
  • 30 Krishna V, McLawhorn M, Kosnik-Infinger L, Patel S. High long-term symptomatic recurrence rates after Chiari-1 decompression without dural opening: a single center experience. Clin Neurol Neurosurg 2014; 118: 53-58
  • 31 Deng X, Yang C, Gan J. , et al. Long-term outcomes after small-bone-window posterior fossa decompression and duraplasty in adults with Chiari malformation type I. World Neurosurg 2015; 84 (04) 998-1004
  • 32 Liang CJ, Dong QJ, Xing YH. , et al. Posterior fossa decompression combined with resection of the cerebellomedullary fissure membrane and expansile duraplasty: a radical and rational surgical treatment for Arnold-Chiari type I malformation. Cell Biochem Biophys 2014; 70 (03) 1817-1821
  • 33 Gürbüz MS, Berkman MZ, Ünal E. , et al. Foramen magnum decompression and duraplasty is superior to only foramen magnum decompression in Chiari malformation type 1 associated with syringomyelia in adults. Asian Spine J 2015; 9 (05) 721-727
  • 34 Förander P, Sjåvik K, Solheim O. , et al. The case for duraplasty in adults undergoing posterior fossa decompression for Chiari I malformation: a systematic review and meta-analysis of observational studies. Clin Neurol Neurosurg 2014; 125: 58-64
  • 35 Hu Y, Liu J, Chen H. , et al. A minimally invasive technique for decompression of Chiari malformation type I (DECMI study): study protocol for a randomised controlled trial. BMJ Open 2015; 5 (04) e007869
  • 36 Lee S, Wang KC, Cheon JE. , et al. Surgical outcome of Chiari I malformation in children: clinico-radiological factors and technical aspects. Childs Nerv Syst 2014; 30 (04) 613-623
  • 37 Bao CS, Liu L, Wang B. , et al. Craniocervical decompression with duraplasty and cerebellar tonsillectomy as treatment for Chiari malformation-I complicated with syringomyelia. Genet Mol Res 2015; 14 (01) 952-960
  • 38 Chotai S, Kshettry VR, Lamki T, Ammirati M. Surgical outcomes using wide suboccipital decompression for adult Chiari I malformation with and without syringomyelia. Clin Neurol Neurosurg 2014; 120: 129-135
  • 39 Gao J, Yang Z, Li YN, Wang RZ. The preliminary study of using neuro-endoscope assisted atlanto occipital decompression to treat Chiari type I malformation with syringomyelia. [in Chinese]. Zhonghua Wai Ke Za Zhi 2010; 48 (19) 1451-1453
  • 40 Narenthiran G, Parks C, Pettorini B. Management of Chiari I malformation in children: effectiveness of intra-operative ultrasound for tailoring foramen magnum decompression. Childs Nerv Syst 2015; 31 (08) 1371-1376
  • 41 Radmanesh A, Greenberg JK, Chatterjee A, Smyth MD, Limbrick Jr DD, Sharma A. Tonsillar pulsatility before and after surgical decompression for children with Chiari malformation type 1: an application for true fast imaging with steady state precession. Neuroradiology 2015; 57 (04) 387-393
  • 42 Bond AE, Jane Sr JA, Liu KC, Oldfield EH. Changes in cerebrospinal fluid flow assessed using intraoperative MRI during posterior fossa decompression for Chiari malformation. J Neurosurg 2015; 122 (05) 1068-1075
  • 43 Menezes AH. Craniovertebral junction abnormalities with hindbrain herniation and syringomyelia: regression of syringomyelia after removal of ventral craniovertebral junction compression. J Neurosurg 2012; 116 (02) 301-309
  • 44 Kandasamy J, Kneen R, Gladstone M, Newman W, Mohamed T, Mallucci C. Chiari I malformation without hydrocephalus: acute intracranial hypertension managed with endoscopic third ventriculostomy (ETV). Childs Nerv Syst 2008; 24 (12) 1493-1497
  • 45 Hayhurst C, Osman-Farah J, Das K, Mallucci C. Initial management of hydrocephalus associated with Chiari malformation type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis. J Neurosurg 2008; 108 (06) 1211-1214
  • 46 Deng X, Wu L, Yang C, Tong X, Xu Y. Surgical treatment of Chiari I malformation with ventricular dilation. Neurol Med Chir (Tokyo) 2013; 53 (12) 847-852
  • 47 Kapoor A, Dhandapani S, Singh P. The triad of holocord syringomyelia, Chiari malformation and tethered cord: amelioration with simple detethering—a case for revisiting traction hypothesis?. Neurol India 2014; 62 (06) 708-709
  • 48 Schuster JM, Zhang F, Norvell DC, Hermsmeyer JT. Persistent/Recurrent syringomyelia after Chiari decompression—natural history and management strategies: a systematic review. Evid Based Spine Care J 2013; 4 (02) 116-125
  • 49 Zakaria R, Kandasamy J, Khan Y. , et al. Raised intracranial pressure and hydrocephalus following hindbrain decompression for Chiari I malformation: a case series and review of the literature. Br J Neurosurg 2012; 26 (04) 476-481
  • 50 Assina R, Meleis AM, Cohen MA, Iqbal MO, Liu JK. Titanium mesh-assisted dural tenting for an expansile suboccipital cranioplasty in the treatment of Chiari 1 malformation. J Clin Neurosci 2014; 21 (09) 1641-1646