RT Journal Article
SR Electronic
T1 Accurate Posterior Fossa Decompression Technique for Chiari Malformation Type I and a Syringomyelia With Navigation: A Technical Note
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 615
OP 622
DO 10.14444/8483
VO 17
IS 4
A1 Tanaka, Masato
A1 Sharma, Sneha
A1 Fujiwara, Yoshihiro
A1 Arataki, Shinya
A1 Omori, Toshinori
A1 Kanamaru, Akihiro
A1 Kodama, Yuya
A1 Saad, Hossam
A1 Yamauchi, Taro
YR 2023
UL https://www.ijssurgery.com/content/17/4/615.abstract
AB Background Posterior fossa decompression (PFD) has been widely accepted for the surgical treatment for Chiari malformation type I (CM1). However, inadequate decompression causes surgical mortality and complications such as cerebrospinal fluid leakage, meningitis, or progression of syrinx and symptoms. The authors report a novel technique of PFD under navigation.Methods Five female patients with CM1 who developed severe symptoms and underwent surgical treatment were evaluated (mean age 14.0 years; mean follow-up 1.3 years). Surgical outcomes, surgical time, intraoperative blood loss, and operative complications were assessed.Results Four patients with CM1 who developed severe symptoms and underwent surgery were evaluated (mean age 14 years; mean follow-up 1.2 years). All patients were treated with PFD, C1 (and partial C2) laminoplasty to decompress the spinal cord under navigation guidance. Suboccipital craniectomy with 3 cm in diameter around the foramen magnum was performed. The postoperative radiograms and computed tomographic images showed adequate bony resection for CM1. Average surgical time was 114 minutes and average blood loss was 82 mL. There were no postoperative complications. After surgery, the numbness and muscle weakness of the patients were improved. The final follow-up magnetic resonance imaging displayed a good decompression of cerebral tonsile, and cervical syringomyelia was decreased.Conclusions PFD under navigation guidance can reduce inappropriate decompression and may decrease a revision surgery. During decompression surgery, cerebrospinal fluid leakage can be prevented using an ultrasonic bone cutter and navigation.Level of Evidence 5.