Efficacy and Safety of Duraplasty in Chiari Malformation Type-I Patients Associated With Syringomyelia

Background Data: Chiari malformation type-I (CM-I) is a challenging subject to wrap our hands around table. Chiari symptoms often range from, unexplained, and/or occipital Valsalva type headache, chronic fatigue syndrome, to lower cranial nerve abnormalities, or brain stem compression, till severe neurological insult which augmented by syringomyelia, or syringobulbia. Exact diagnostic and prognostic tools carry a great controversy which ranged from simple MRI study to MR imaging–based CSF velocity measurements, morphological, dynamic craniocervical junction assessments, subarachnoid pressure recordings, and compliance calculations were compared before and after surgical treatment. Purpose: This study aimed to estimate the efficacy and safely of duraplasty in CM-I patients associated with yringomyelia. Study Design: A retrospective descriptive clinical case study. Patients and Methods: The study was conducted on 23 consecutive adults patients with CM-I associated with syringomyelia. They underwent surgical treatments at Sohag University Hospital from February 2012 to May 2015. Results: The current study was applied to 23 patients; 10 males (43.5%) and 13 females (56.5%), aged 18-64 with a mean age of 41 years. The duration of symptoms before presentation varied from 1 month to 20 years. Clinical outcome was classified according to Glasgow outcome scale, 21 patients (91.3%) were graded V, 2 patients (8.7%) were grade IV, and no patient graded I. Radiologically MRI craniocervical junction suggested that decompression of the posterior fossa was achieved in all patients. Post-operative reports showed that no deterioration occurred in any of our patients. Improvement occurred and increased gradually on post-operative period. Conclusion: Craniocervical decompression with duraplasty is effective in treating patients with Chiari Malformation type-I with syringomyelia. Both clinical and radiologic improvement was documented on the follow up period. (2015ESJ099