Long-term surgical outcome of Chiari type-I malformation-related syringomyelia: an experience of tertiary referral hospital

ABSTRACT

Objective

Syringomyelia is a common condition seen in patients with Chiari type-I malformation (CM1). The purpose of this retrospective study was to evaluate the long-term clinical and radiological outcomes of posterior fossa decompression with duraplasty (PFDD) with coagulation of tonsillar ectopia in consecutive surgically treated adult patients with CM1-related syringomyelia (CRS).

Methods

Over 9 years’ duration (1993–2001), medical charts of diagnosed patient with CM1 at our neurosurgical center were reviewed retrospectively. This study included adult patients with CM1 who had syringomyelia and underwent PFDD with coagulation of tonsillar ectopia surgery. The differences between the pre- and postoperative syrinx/cord ratio (S/C), the syrinx length, and the regression of herniated cerebellar tonsils on coronal and midsagittal MRIs were evaluated.

Results

A total of 87 surgical procedures (46 primary operations, 7 ventriculoperitoneal shunts, and 34 additional operations) for CRS were performed on 24 males and 22 females. The mean preoperative S/C was 0.59 ± 0.12. The means of regression in herniated cerebellar tonsils on mid-sagittal and coronal images were 11.8 ± 2.3 mm and 10.2 ± 2.2 mm (p < 0.0001), respectively. 35 (76.1%) patients were discharged after showing signs of recovery or improvement. Different complications occurred in 16 (34.8%) patients. Negative correlations were noticed between postoperative recovery/improvement and the long symptoms’ duration, the herniated tonsils’ extent, S/C, and the persistence of the herniated tonsils on the coronal images.

Conclusion

Early diagnosis of patients with CRS can improve surgical outcomes. Due to its efficacy in resolving clinical symptoms and syrinx cavities, PFDD is still an optimal surgical approach for CRS.

KEYWORDS:

• Chiari type-I malformation
• syringomyelia
• Chiari type-I malformation-related syringomyelia
• surgical treatment
• long-term outcomes

Abbreviations

Table

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Anas Abdallah

Anas Abdallah**: Conceptualization, Methodology, Software, Supervision, Formal analysis, Statistical analysis, Literature review, Visualization, Investigation, Writing – Original draft, Supervision, Writing – Review, and Validation.

İrfan Çınar

İrfan Çınar**: Conceptualization, Methodology, Supervision, Formal analysis, Visualization, Investigation, Writing – Original draft, Supervision, and Validation.

Betül Güler Abdallah

Betül Güler Abdallah**: Conceptualization, Methodology, Supervision, Formal analysis, Statistical analysis, Literature review, Visualization, Investigation, Writing – Original draft, Supervision, and Validation.