Foramen magnum decompression with cervical syringotomy for Chiari malformation type I with syringomyelia - A useful adjunct in selected cases.

Abstract

Persistent or worsening syringomyelia after foramen magnum decompression (FMD) for Chiari I malformation (CIM) can be challenging to manage. We present a previously unpublished surgical technique of FMD with concomitant cervical syringotomy in selected patients. A retrospective analysis of prospectively collected data was carried out. Patients who underwent FMD and expansion duraplasty (FMDD) with concomitant syringotomy were collected. Three patients with CIM with high cervical syringomyelia who underwent FMDD with concurrent syringotomy were identified. All cases had an idiopathic CIM. Improvement in clinical symptoms was noticed in all patients. Early postoperative imaging (within 6 weeks-4 months) showed syrinx transverse diameter reduction in the range of 85-100%. There were no postoperative complications. FMDD with concurrent high cervical syringotomy through a standard approach in selected cases of CIM with high cervical syringes achieves clinical improvement without additional complications.