Reoperation in Chiari-1 Malformations
(1) Background: The issue of unsuccessful surgery for Chiari-1 malformation (CM-1), as well as its potential causes and possible solutions, remains poorly documented and studied. (2) Methods: From a retrospective review of a personal series of 98 patients undergoing treatment for CM-1 during the pas...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/8/2853 |
| _version_ | 1797604918304964608 |
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| author | Giuseppe Talamonti Marco Picano Maria Fragale Eleonora Marcati Giulia Meccariello Davide Boeris Marco Cenzato |
| author_facet | Giuseppe Talamonti Marco Picano Maria Fragale Eleonora Marcati Giulia Meccariello Davide Boeris Marco Cenzato |
| author_sort | Giuseppe Talamonti |
| collection | DOAJ |
| description | (1) Background: The issue of unsuccessful surgery for Chiari-1 malformation (CM-1), as well as its potential causes and possible solutions, remains poorly documented and studied. (2) Methods: From a retrospective review of a personal series of 98 patients undergoing treatment for CM-1 during the past 10 years, we created two study groups. Group 1: 8 patients (8.1%) requiring additional surgeries owing to postoperative complications (7 cerebrospinal fluid leakage, 1 extradural hematoma); 7 patients (7.1%) undergoing reoperations for failed decompression during the follow-up. Group 2: During the same period, we also managed 19 patients who had previously been operated on elsewhere: 8 patients who required adequate CM-1 treatment following extradural section of the filum terminale; 11 patients requiring reoperations for failed decompression. Failed decompression was managed by adequate osteodural decompression, which was associated with tonsillectomy (6 cases), subarachnoid exploration (8 cases), graft substitution (6 cases), and occipito-cervical fixation/revision (1 case). (3) Results: There was no mortality or surgical morbidity in Group 1. However, one patient’s condition worsened due to untreatable syrinx. In Group 2, there were two cases of mortality, and surgical morbidity was represented by functional limitation and pain in the patient who needed revision of the occipitocervical fixation. Twenty patients improved (58.8%), 6 remained unchanged (32.3%), 1 worsened (2.9%) and 2 died (5.9%). (4) Conclusions: The rate of complications remains high in CM-1 treatment. Unfortunately, a certain rate of treatment failure is unavoidable, but it appears that a significant number of re-operations could have been avoided using proper indications and careful technique. |
| first_indexed | 2024-03-11T04:53:35Z |
| format | Article |
| id | doaj.art-0294b86ebd4a4fbe9d9b110d21f67945 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T04:53:35Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0294b86ebd4a4fbe9d9b110d21f679452023-11-17T19:49:25ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01128285310.3390/jcm12082853Reoperation in Chiari-1 MalformationsGiuseppe Talamonti0Marco Picano1Maria Fragale2Eleonora Marcati3Giulia Meccariello4Davide Boeris5Marco Cenzato6Department of Neurosurgery, ASST Niguarda, 20162 Milan, ItalyDepartment of Neurosurgery, ASST Niguarda, 20162 Milan, ItalyDepartment of Neurosurgery, ASST Niguarda, 20162 Milan, ItalyDepartment of Neurosurgery, ASST Niguarda, 20162 Milan, ItalyDepartment of Neurosurgery, ASST Niguarda, 20162 Milan, ItalyDepartment of Neurosurgery, ASST Niguarda, 20162 Milan, ItalyDepartment of Neurosurgery, ASST Niguarda, 20162 Milan, Italy(1) Background: The issue of unsuccessful surgery for Chiari-1 malformation (CM-1), as well as its potential causes and possible solutions, remains poorly documented and studied. (2) Methods: From a retrospective review of a personal series of 98 patients undergoing treatment for CM-1 during the past 10 years, we created two study groups. Group 1: 8 patients (8.1%) requiring additional surgeries owing to postoperative complications (7 cerebrospinal fluid leakage, 1 extradural hematoma); 7 patients (7.1%) undergoing reoperations for failed decompression during the follow-up. Group 2: During the same period, we also managed 19 patients who had previously been operated on elsewhere: 8 patients who required adequate CM-1 treatment following extradural section of the filum terminale; 11 patients requiring reoperations for failed decompression. Failed decompression was managed by adequate osteodural decompression, which was associated with tonsillectomy (6 cases), subarachnoid exploration (8 cases), graft substitution (6 cases), and occipito-cervical fixation/revision (1 case). (3) Results: There was no mortality or surgical morbidity in Group 1. However, one patient’s condition worsened due to untreatable syrinx. In Group 2, there were two cases of mortality, and surgical morbidity was represented by functional limitation and pain in the patient who needed revision of the occipitocervical fixation. Twenty patients improved (58.8%), 6 remained unchanged (32.3%), 1 worsened (2.9%) and 2 died (5.9%). (4) Conclusions: The rate of complications remains high in CM-1 treatment. Unfortunately, a certain rate of treatment failure is unavoidable, but it appears that a significant number of re-operations could have been avoided using proper indications and careful technique.https://www.mdpi.com/2077-0383/12/8/2853Chiari malformationCSF-leakcomplicationsforamen magnum decompressionreoperationsyringomyelia |
| spellingShingle | Giuseppe Talamonti Marco Picano Maria Fragale Eleonora Marcati Giulia Meccariello Davide Boeris Marco Cenzato Reoperation in Chiari-1 Malformations Journal of Clinical Medicine Chiari malformation CSF-leak complications foramen magnum decompression reoperation syringomyelia |
| title | Reoperation in Chiari-1 Malformations |
| title_full | Reoperation in Chiari-1 Malformations |
| title_fullStr | Reoperation in Chiari-1 Malformations |
| title_full_unstemmed | Reoperation in Chiari-1 Malformations |
| title_short | Reoperation in Chiari-1 Malformations |
| title_sort | reoperation in chiari 1 malformations |
| topic | Chiari malformation CSF-leak complications foramen magnum decompression reoperation syringomyelia |
| url | https://www.mdpi.com/2077-0383/12/8/2853 |
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