Long-term Outcomes of a New Minimally Invasive Approach in Chiari Type 1 and 1.5 Malformations: Technical Note and Preliminary Results.

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Long-term Outcomes of a New Minimally Invasive Approach in Chiari Type 1 and 1.5 Malformations: Technical Note and Preliminary Results.

World Neurosurg. 2018 Apr 23;:

Authors: Kotil K, Ozdogan S, Kayaci S, Duzkalir HG

Abstract
PURPOSE: The treatment options for patients with Chiari malformation type-1(CM1) and Chiari malformation type-1.5(CM1.5) have not yet been standardized. In these malformations, the main factors include obstruction at the level of the foramen magnum, dural and ligamentous thickening. Here we have presented our outcomes of surgery and decompression using minimal invasive surgery(MIS) technique.
MATERIALS AND METHODS: Sixty-one patients admitted to our clinics between 2009 and 2016 due to CM1 or CM1.5, and who had undergone MIS, were investigated retrospectively. All patients were followed-up for a mean period of 55 months, both clinically and radiologically, and the outcomes were recorded.
RESULTS: All patients underwent foramen magnum decompression through a 1.5 cm mini-open incision, C1 laminectomy and C2 medial inner side tour, posterior atlanto-occipital membrane removal, external dural delamination, and widening of the internal dura with longitudinal incisions. Fifty-six patients (91.8%) were satisfied, 4 (6.5%) remained the same, and 1 (1.6%) reported a poor outcome. Forty-five percent of those patients with syringomyelia demonstrated resolution within 2 years, and 92% demonstrated resolution in 5 years. Scoliosis was seen in 5 patients (8.1%). The benefit rate from the surgical procedure was statistically significant (p=0.0045), and none of the patients required additional surgery due to poor decompression.
CONCLUSIONS: MIS is effective for non-complicated cases of CM1 and CM1.5 due to its minimal connective and muscular tissue damage, short surgical duration, short recovery time, early mobilization, effective posterior foramen magnum widening, lack of liquor fistula development, and better clinical and radiological improvement during the long-term follow-up.

PMID: 29698796 [PubMed - as supplied by publisher]

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