Comparison Study between Posterior Fossa Decompression with Duroplasty and Posterior Fossa Decompression without Duroplasty, in 20 Cases of Chiari I Malformation

Introduction: Chiari malformation Type I (CM-I) is typically defined as descent of the caudal tip of cerebellar tonsils at least 5 mm below the foramen magnum. The incidence of the malformation is not exactly known. Treatment of Chiari I malformation is debatable. Some advocate posterior fossa decompression (PFD) with duroplasty and others advocate posterior fossa decompression only without duroplasty. Aim of the Study: To compare the outcomes of patients who undergoing PFD with duroplasty and PFD without duroplasty, in Chiari I malformation. Patients and Methods: In the period between “January 2015-June 2016”, a prospective study was conducted involving 20 patients complaining of headache, motor and/or sensory affection secondary to Chiari I malformation. These patients were randomly divided into 2 groups. The first one had PFD with duroplasty and the other will have PFD without duroplasty. All patients had chiari one malformation in form of tonsillar herniation and cervical or cervico-dorsal syrinx. The average follow-up period was 9 months. Results: Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up. There were no major complications. The mean length of hospital stay was 2.0 days. There was no perioperative death or neurological deterioration. The use of duroplasty was significantly associated with presence of complications and longer duration of hospital stay. Conclusion: PFD without duroplasty in cases of chiari I malformation carries a good results as well as PFD with duroplasty with lower risk of complications.

Chiari Malformation Type 1 in Adults Managed by Surgical Decompression: New Prospective

Aim of the work: This study aims to assess the value of the surgical management in the improvement of the symptoms & signs of patients with Chiari malformation type 1 and radiological follow up in adults. Patients and methods: This study included 30 consecutive patients with Chiari malformation type I who were indicated for surgery at neurosurgery department. Data were collected prospectively from the involved patients who were evaluated preoperatively and underwent evaluation by CT scanning of the brain & skull and MRI imaging of the brain and spine. CT and MRI were done as the routine follow up investigations for all patients. We operated through midline suboccipital craniectomy, durotomy in y shaped manner, shrinkage of cerebellar tonsils by bipolar electrocautery, duroplasty by fascia lata graft, watertight closure. Results: The assessment from E. J. N. S. (Egyptian Journal of Neurosurgery) vol. 24 no. 2 June 2009 used for evaluating the patients clinically. 18 patients reported good outcome, 6 fair, 6 poor. We evaluated the size of the syrinx if present preoperative in follow up. 15 (50%) patients showed marked reduction (more than or equal to 60%) in size of syrinx, 3 (10%) mild reduction (less than or equal to 30%) in size and 12 (40%) with no change. Conclusion: The Chiari type 1 malformation constitutes a controllable malformation with good outcomes. With current microsurgical techniques, the results of the bony decompression and duroplasty became excellent. Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications.

Outcome of Early Surgical Decompression in Traumatic Incomplete Spinal Cord Injury

Objectives: Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims to determine the efficacy of early surgical decompression (within 24 hours) of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases. Methods: 60 patients suffering from acute traumatic central cord syndrome with various neurological deficits were divided into 2 groups, group A (conservatively managed) and group B (surgically managed). Patients in group B were operated upon within 24 hr. of trauma by posterior decompression. Clinical assessment of each patient on admission, discharge and 3 months follow-ups was done using the ASIA Impairment Scale, FIM, Ashworth scale, bladder function, and neuropathic pain symptoms. Results: Data collected from both groups showed, group A (the conservative group) consisted of 22 male (73.3%) and 8 female subjects (26.6%) with a mean age of 57.5 years while in group B (surgical group) the sample consisted of 20 male (66.6%) and 10 female subjects (33.3%) with a mean age of 58.6 years. There was an improvement in our study—according to ASIA and FIM scales—in 8 patients of 30 (26.6%) in the conservative group. In the surgical group, improvement in 16 patients (53.3%). Conclusions: Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay.