Turkish Neurosurgery 2010 , Vol 20 , Num 3
The Evaluation of Surgical Treatment Options in the Chiari Malformation Type I
Ersin ERDOGAN1, Tufan CANSEVER2, Halil Ţbrahim SECER3, Caglar TEMIZ4, Sait SIRIN5, Serdar KABATAS6, Engin GONUL7
1,3,4,5,7GATA, Department of Neurosurgery, Ankara, Turkey
2,6Ba■kent University, Department of Neurosurgery, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.2648-09.2 AIM: There have been several treatment modalities to reduce the volume of the syringomyelic cavity and the pressure on the brainstem in Chiari Malformation Type I (CM-I). Foramen magnum decompression with and without duroplasty were compared in this retrospective study.

MATERIAL and METHODS: From 2003 to 2006, 27 patients suffering from CMI were operated on at our institute. The following were measured: the ratio of the syringomyelic cavity to the spinal cord; pre-operative tonsillar herniation from the foramen magnum; pre- and postoperative tonsillo-dural distance; and spinoposterior fossa dural angle.

RESULTS: 83.3 % of the patients in the non-duroplasty and 73.3% of the patients in the duroplasty group were symptom free. The ratio of syrinx regression was 28▒10% in the non-duroplasty and 36▒33% in the duroplasty group. The tonsillodural distance was 3.1▒1.8 mm in the non-duroplasty and 4.6▒2.1 mm in the duroplasty group (p>0.05). The spino-posterior fossa dural angle was 133.6▒9.44║ preoperatively and 136.7 ▒ 9.78║ postoperatively in the non-duroplasty (p=0.376); 123.7▒11.7║ preoperatively and 129.8▒11.1║ postoperatively in the duroplasty group (p=0.885); no significant difference was found postoperatively (p=0.55, z=1.92), respectively. One patient was re-operated in the non-duroplasty group and thereafter duroplasty was performed.

CONCLUSION: Almost the same clinical outcomes can be achieved with and without duroplasty. There might be an option to perform duroplasty if simple procedure fails. Keywords : Arnold-Chiari Malformation, Therapeutics, Combined Modality Therapy

Corresponding author : Tufan Cansever, drtufan@gmail.com