Tag: Chiari

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Predecompression and postdecompression cognitive and affective changes in Chiari malformation type I

J Neurosurg 143:4–12, 2025

This prospective study found that patients with Chiari malformation type I commonly experience cognitive and psychiatric impairments, particularly in executive function and visuospatial memory. Following posterior fossa decompression surgery, 89% showed significant improvement in cognitive and/or psychiatric symptoms, highlighting the cerebellum’s role in these functions.

• Chiari malformation type I (CM-I) patients often have unrecognized cognitive and psychiatric symptoms, including deficits in executive function, visuospatial memory, and increased depression, anxiety, and related symptoms.

• This prospective study assessed 54 CM-I patients with cognitive or psychiatric complaints before and after posterior fossa decompression (PFD) surgery.

• Preoperatively, patients performed worse than normative samples in executive function and visuospatial memory, and reported more psychiatric symptoms across all measured domains.

• Six months after surgery, 89% of patients showed clinically significant improvements (>1 SD) in cognitive and/or psychiatric domains.

• Improvements were most notable in visuospatial memory and psychiatric symptoms such as depression and anxiety, which normalized to levels seen in the general population.

• Patients with the most severe preoperative deficits experienced the greatest postoperative improvements.

• The findings support a key role for the cerebellum in cognitive and psychiatric dysfunction and suggest that some symptoms in CM-I are potentially treatable with targeted cerebellar intervention.

• Limitations include lack of a control group and focus on symptomatic, self-reporting patients, so results may not generalize to all CM-I cases.

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Single-stage correction of severe scoliosis with syringomyelia: performed with traction assistance without prophylactic neurosurgical decompression

J Neurosurg Spine 41:316–324, 2024

There is still controversy about whether it is necessary to perform prophylactic neurosurgical decompression for severe scoliosis (SS) with syringomyelia (SM) to reduce the risk of neurological complications during subsequent spinal correction. This study aimed to explore the safety and effectiveness of using traction-assisted single-stage spinal correction as a treatment for patients who had SS with SM (SS-SM).

METHODS The patients who had SS-SM without previous neurosurgical intervention and who underwent traction-assisted single-stage posterior spinal correction at a single center were included, and the initial, posttraction, and postoperative clinical data were reviewed. Based on preoperative MRI, the included patients were divided into two categories: those with versus those without Chiari malformation type I (CM-I–related SM [CS] vs idiopathic SM [IS]), and those with a moderate syrinx (MS) versus those with a large syrinx (LS). Different groups’ traction and operation contributions were calculated for comparisons (CS vs IS, MS vs LS).

RESULTS A total of 28 patients were included. The initial mean major scoliosis was 101.0° with a mean flexibility of 21.4%. After the operation, the mean total correction rate for scoliosis was 63.9%. The mean traction and operation contributions were 61.5% and 38.5%, respectively. Most of the patients (75%) underwent spinal corrections without 3-column osteotomies, and only 1 patient reported postoperative regional numbness without motor deficits. No differences were found in the mean total correction rates, traction, and operation contributions when comparing CS versus IS and MS versus LS with the comparable initial clinical data (p > 0.05). More than 50% of the total corrections were achieved by preoperative traction in all groups.

CONCLUSIONS Traction-assisted single-stage spinal correction can safely and effectively correct SS-SM without prophylactic neurosurgical decompression under strict patient selection. Additionally, traction can achieve more than half of the final spinal correction, even for patients with varying sizes of SMs.

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Complications following decompression of Chiari malformation Type I in children: dural graft or sealant?

J Neurosurg Pediatrics 8:177–183, 2011. DOI: 10.3171/2011.5.PEDS10362

Posterior fossa decompression with duraplasty for Chiari malformation Type I (CM-I) is a common pediatric neurosurgery procedure. Published series report a complication rate ranging from 3% to 40% for this procedure. Historically, many dural substitutes have been used, including bovine grafts, human cadaveric pericardium, synthetic dura, and autologous pericranium. The authors hypothesized that a recently observed increase in complications was dependent on the graft used.

Methods. Between January 2004 and January 2008, 114 consecutive patients ≤ 18 years old underwent primary CM-I decompression using duraplasty. Records were retrospectively reviewed for short- and intermediate-term complications and operative technique, focusing on the choice of duraplasty graft with or without application of a tissue sealant.

Results. The average age of the patients was 8.6 years. The dural graft used was variable: 15 were treated with cadaveric pericardium, 12 with Durepair, and 87 with EnDura. Tisseel was used in 75 patients, DuraSeal in 12, and no tissue sealant was used in 27 patients. The overall complication rate was 21.1%. The most common complications included aseptic meningitis, symptomatic pseudomeningocele, or a CSF leak requiring reoperation. The overall complication rates were as follows: cadaveric pericardium 26.7%, Durepair 41.7%, and EnDura 17.2%; reoperation rates were 13%, 25%, and 8.1%, respectively. Prior to adopting a different graft product, the overall complication rate was 18.1%; following the change the rate increased to 35%. Complication rates for tissue sealants were 14.8% for no sealant, 18.7% for Tisseel, and 50% for DuraSeal. Nine patients were treated with the combination of Durepair and DuraSeal and this subgroup had a 56% complication rate.

Conclusions. Complication rates after CM-I decompression may be dependent on the dural graft with or without the addition of tissue sealant. The complication rate at the authors’ institution approximately doubled following the adoption of a different graft product. Tissue sealants used in combination with a dural substitute to augment a duraplasty may increase the risk of aseptic meningitis and/or CSF leak. The mechanism of the apparent increased inflammation with this combination remains under investigation.

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