Surgical Treatment of Symptomatic Chiari I Malformation

Abstract

Background: There is lack of consensus on the most appropriate surgical management for Chiari malformation type I (CM I), the extent of decompression, and on the management of patients with Chiari I who also have associated scoliosis or syringomyelia, and the signs and symptoms can be attributed to these but not to compression on the posterior fossa. We present our surgical results with CM I and compare outcomes on the basis of clinical presentation, surgical approaches, and types of graft materials used. Methods: We retrospectively reviewed the charts of 37 consecutive patients. Presenting complaints, imaging studies, and different patient management strategies were analyzed with respect to outcomes and complications. Results: There were 27 male and 10 female patients with a mean age of 25.7±13.9 years at the time of admission. Comparisons based on age, sex, and extent of laminectomy were found to be statistically insignificant. There was also no significant difference between posterior fossa decompression with duraplasty and posterior fossa decompression in symptomatic improvement of the patients. Posterior fossa decompression with duraplasty was found to be associated with a higher risk of developing CSF leaks but a lower risk of reoperation. Conclusions: CM I should be considered in the list of differentials in patients with nonspecific headaches and neck pains. Timely surgical intervention for symptomatic CM I patients can lead to significant clinical improvement. However, the extent of decompression, the need for duraplasty, and the choice of graft material lack general consensus. In CM I patients with associated scoliosis and syringomyelia, decompressive surgery may halt further progression of the spinal abnormalities.