Abstract
The correlation between hydrocephalus and Chiari type I malformation (CIM) has been debated since Chiari’s first descriptions of CIM but some studies have shown that CIM and hydrocephalus (HCP) could cause symptoms/disease of each other or vice versa. Recent research has found that treatment focused on hydrocephalus with ventricle enlargement also provides alleviation of CIM and even of syringomyelia. However, the lack of consensus among previous studies left unanswered the question of how endoscopic third ventriculostomy (ETV) addresses CIM and why it fails. Ten symptomatic hydrocephalic patients associated with CIM underwent ETV from October 2002 to May 2012. The clinical features and neuroimaging of all patients were reviewed. Statistical analysis was applied to evaluate the changes in the tonsillar ectopia and the ventricle dilation after operation. The mean follow-up period of this series was 92 months (range 24–163 months). Eight patients (80%) remained shunt free or experienced symptom relief following ETV. The remaining two patients were identified as failures due to the deterioration of symptoms or subsequent hindbrain decompression. Endoscopic third ventriculostomy provides an effective treatment for hydrocephalus associated with CIM, which can relieve HCP and improve the symptoms of CIM in most patients. The clinical outcomes are related to the major cause of the tonsillar herniation.
Highlights
The correlation between hydrocephalus and Chiari type I malformation (CIM) has been debated since Chiari’s first descriptions of CIM
Chiari postulated that the caudal descent of the cerebellar tonsils, which was later named BChiari type I malformation^, was the result of the supratentorial pressure exerted by long-standing hydrocephalus
The study group was composed of ten inpatients consecutively treated for symptomatic hydrocephalus associated with CIM by endoscopic third ventriculostomy (ETV) in our single neurosurgical institute from October 2002 until May 2012
Summary
The correlation between hydrocephalus and Chiari type I malformation (CIM) has been debated since Chiari’s first descriptions of CIM. There was not an obvious difference between the outcomes in adults and children in these studies Some of these studies achieved complete alleviation of the symptoms induced by both hydrocephalus and CIM and even a reduction of tonsillar herniation and syringomyelia. Our retrospective study complemented previous work with the aim of identifying the efficacy of ETV through the outcomes, analysing the morphological variation and the mutual effect on both hydrocephalus and CIM, trying to interpret how ETV succeeds or fails. This is the only report to date on a Chinese population. Statistical analysis was performed using Student’s t test with significance set at p < 0.05
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