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Management of Chiari I malformation in children: effectiveness of intra-operative ultrasound for tailoring foramen magnum decompression

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Abstract

Purpose

Patients with Chiari I malformation (CM-1) commonly undergo foramen magnum decompression (FMD). However, there is no consensus on how this should be achieved. An approach would be to rationalize surgical steps based on pre-operative imaging and intra-operative findings. The aim of this study is to assess the usefulness of intra-operative ultrasound scanning (IOUS) in tailoring foramen magnum decompression in children with CM-1 and whether the use of IOUS is effective in reducing the risk of complications without increasing the need for re-operation.

Method

We performed a retrospective study. IOUS was utilized during FMD: a subjective assessment was made on whether there was adequate cerebellar tonsillar and/or CSF pulsation following suboccipital craniectomy. If there was adequate pulsation, the dura was not opened. Additional data were collected including age and gender of patients, presence of pre-operative syringomyelia, intra-operative ultrasound findings, length of follow-up, complications and radiological and clinical outcome. The statistical analysis was performed with XLStat®(Addinsoft SARL™, France).

Results

Nineteen patients underwent FMD from June 2011 to December 2012. The mean age was 10.5 years; there were nine females and ten males. Eleven patients had syringomyelia at diagnosis. Based on IOUS, eight patients underwent dural decompression and 11 patients bony decompression only. One patient had a post-operative pseudomeningocoele and two patients required re-operation. There was no significant statistical difference between the two groups regarding post-operative improvement in the syrinx.

Conclusion

We found that tailoring FMD for patients with CM-1 using intra-operative findings using ultrasound scan was useful in avoiding unnecessary manoeuvres, while not compromising on the outcome.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Alder Hey Children’s Hospital NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK

    Ganesalingam Narenthiran, Christopher Parks & Benedetta Pettorini

Authors
  1. Ganesalingam Narenthiran
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  2. Christopher Parks
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  3. Benedetta Pettorini
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Correspondence to Benedetta Pettorini.

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Narenthiran, G., Parks, C. & Pettorini, B. Management of Chiari I malformation in children: effectiveness of intra-operative ultrasound for tailoring foramen magnum decompression. Childs Nerv Syst 31, 1371–1376 (2015). https://doi.org/10.1007/s00381-015-2699-1

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  • DOI: https://doi.org/10.1007/s00381-015-2699-1

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