Postoperative dynamics of syringomyelia associated with Chiari Type 1 malformation and its predictors.

Abstract

The main treatment for syringomyelia associated with Chiari Type 1 malformation is surgery – decompression of posterior cranial fossa, in order to eliminate the cerebrospinal fluid flow block at the craniovertebral transition level.  However, successful surgical treatment does not always lead to regression of syringomyelia symptoms.  The literature presents controversial data about factors affecting the postoperative outcome. We examined 44 patients, who underwent decompression of the posterior cranial fossa, in order to assess the postoperative dynamics of syringomyelia associated with Chiari Type 1 malformation and to identify predictive factors.  Analysis of clinical and neurovisual parameters before surgery and at the distant postoperative stage (2 years or more after treatment) made it possible to determine the frequency of the dynamics of spinal symptoms and symptoms of the large occipital foramen and identify the main factors affecting the postoperative outcome.

References

[1] 1. Gardner W.J. Hydrodynamic mechanism of syringomyelia: its relationship to Myelocele. J Neurol Neurosurg Psychiatry. 1965; 28: 247– 259.

[2] 2. Williams B. Progress in syringomyelia. Neurol Res. 1986; 8: 130–145. DOI:10.1080/01616412.1986.11739745

[3] 3. Oldfield E. H., Muraszko K., Shawker T. H. et al. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Journal of Neurosurgery. 1994; 80(1): 3–15. DOI:10.3171/jns.1994.80.1.0003

[4] 4. Klekamp J. Hindbrain-Related Syringomyelia. Syringomyelia: Springer. 2014; P. 141‒166.

[5] 5. Munshi I., Frim D., Stine‑Reyes R. et al. Effects of posterior fossa decompression with and without duraplasty on Сhiari malformation‑associated hydromyelia. Neurosurgery. 2000; 46: 1384– 9. DOI:10.1097/00006123-200006000-00018

[6] 6. Attenello F.J., McGirt M.J., Gathinji M. et al. Outcome of Chiari-associated syringomyelia after hindbrain decompression in children: analysis of 49 consecutive cases. Neurosurgery. 2008; 62 (6): 1307– 13. DOI:10.1227/01.NEU.0000316848.55059.51

[7] 7. Aghakhani N., Parker F., David P. et al. Long-term follow-up of Сhiari-related syringomyelia in adults. Neurosurgery. 2009; 64(2): 308–315. DOI:10.1227/01.neu.0000336768.95044.80

[8] 8. Kumar A., Pruthi N., Devi B.I. et al. Response of syrinx associated with Chiari I malformation to posterior fossa decompression with or without duraplasty and correlation with functional outcome: A prospective study of 22 patients. J Neurosci Rural Pract. 2018; 9: 587–92. DOI:10.4103/jnrp.jnrp_10_18

[9] 9. Wetjen N.M., Heiss J.D., Oldfield E.H. Time course of syringomyelia resolution following decompression of Chiari malformation Type I. J Neurosurg Pediatr. 2008; 1(2): 118–23.

[10] 10. Attal N., Parker F., Tadi M. et al. Effects of surgery on the sensory deficits of syringomyelia and predictors of outcome: a long term prospective study. J Neurol Neurosurg Psychiatry. 2004; 75(7): 1025–30. DOI:10.1136/jnnp.2003.026674

[11] 11. Anderson N. E., Willoughby E. W., Wrightson P. The natural history and the influence of surgical treatment in syringomyelia. Acta Neurologica Scandinavica. 1985; 71(6): 472–479. DOI:10.1111/j.1600-0404.1985.tb03230.x

[12] 12. Sakamoto H., Nishikawa M., Hakuba A. et al. Expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation. Acta Neurochir. 1999; 141: 949–961. DOI:10.1007/s007010050401

[13] 13. Thakar S., Sivaraju L., Jacob K. S. et al. A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients. Journal of Neurosurgery: Spine. 2018; 28(1): 23–32. DOI:10.3171/2017.5.spine17264

[14] 14. Hayhurst C., Richards O., Zaki H. et al. Hindbrain decompression for Chiari‑syringomyelia complex: An outcome analysis comparing surgical techniques. Br J Neurosurg. 2008; 22: 86–91. DOI:10.1080/02688690701779525

[15] 15. Nakamura M., Chiba K., Nishizawa T. et al. Retrospective study of surgery-related outcomes in patients with syringomyelia associated with Chiari I malformation: clinical significance of changes in the size and localization of syrinx on pain relief. J Neurosurg. 2004; 100 (3): 241–4.

RIGHTS & PERMISSIONS

Nurullina C.S., Mendelevich E.G.