Our Experience in Surgical Treatment of Chiari Type 1 Malformations
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Introduction: There are four types of Arnold Chiari Malformation type 1 described in the literature. Due to the fact that it is acommon finding in the general population (true Chiari being present in 0,75% of the population), Arnold Chiari Malformation type 1 was also called Chiari anomaly. Material and methods: In the last 7 years 9 patients with Arnold Chiari Malformation type 1 have been treated in our institution. There were 6 women and 3 men. The mean age was 36,3 years (between 19 and 58 years). The symptoms were grouped in 5 syndromes: brain stem and bulbar palsy syndrome, cerebellar syndrome, central cord syndrome, paroxysmal intracranial hypertension, pyramidal syndrome. Surgical treatment: According to recent literature patients respond best when operated within 2 years from the onset of symptoms. We recommend early surgery for symptomatic patients. Surgical treatment of Chiari I malformation should accomplish several golds. First of all, there is the obvious need to decompress the lower part of the cerebellum. Chiari I malformation being related to a small posterior fossa, the surgical treatment should realise enlargement of the total volume of the posterior fossa. In the author’s opinion the key point in surgical treatment of Chiari 1 malformation should be to reestablish the CSF flow at the level of the foramen of Magendie and foramen magnum. The approaches were used in the last seven years in our Institution for the treatment of symptomatic patients is osseus decompression with dural grafting and intradural dissection of adhesions in all patient Results: The long-term (6 months postoperative) surgery-related result was considered excellent if symptoms resolved (0 patients). The result was considered good if the patient experienced significant improvement but also residual symptoms (8 patients). A poor result indicated no change in symptoms (1 patients). Conclusions: Regarding Chiari I malformations, the author considers that a proper patient selection is critical to prevent unnecessary procedures and maximize the outcome. In light of this study results and recent literature, the author considers that the surgical gold standard consists in threem key steps: posterior fossa craniectomy followed by durotomy and subarachnoid decompression of CSF flow and last duroplasty.