Chiari I malformations; clinical presentations, diagnosis and management

Dr. Ramanjulu Mala; Dr. Rama Mohan Naik Ramachandra; Dr. Ananth  Mugi Lakshmi; Dr.Nagaraju Bugude Nagireddy; Dr.Ram Balaji Naik Gonavath; Dr. Venkateswara Rao Chiniga

Volume : IV, Issue : V, May - 2015

Chiari I malformations; clinical presentations, diagnosis and management

Dr. Ramanjulu Mala, Dr. Rama Mohan Naik Ramachandra, Dr. Ananth Mugi Lakshmi, Dr. Nagaraju Bugude Nagireddy, Dr. Ram Balaji Naik Gonavath, Dr. Venkateswara Rao Chiniga

Abstract :

Background: In this study we have evaluated the clinical presentations, diagnosis, intraoperative findings and clinical outcome in patients with Chiari I malformations undergoing posterior cranial fossa decompression Materials and Methods: Outcome was assessed by Thirty patients with different age groups with Chiari I malformations who underwent suboccipital craniectomy and wide duroplasty .The clinical evaluation of postoperative signs and symptoms and magnetic resonance imaging of the cranioverteal junction were analyzed. Results: Headache in 24(80%) patients and neck pain in18 (54%) were the most common symptoms. Syringomyelia was present in 21 patients (21%).scoliosis in 4 patients (12%), basilar invagination in 2 patients (6%). Female predominance of the malformation was observed, with a female: male ratio of 3:2.The mean age of onset was 27 years and 7 months. No reported positive family history. All patients had descent of cerebellar tonsils. The cerebellar tonsils were found to lie at C1 and C2 in 24 and 6 patients respectively. All patients underwent suboccipital decompresssion and autologous duroplasty using fascia lata in 18 patients and G patch (prolene) in 12 patients. The immediate postoperative period,24(91 %) of patients showed improved symptomatology and post operative magnetic resonance imaging revealed favourable findings comprising syrinx collapse or reduction of syrinx diameter in 85 % of patients. The mean follow–up period was 3 years and 4months. There was no mortality associated with the procedure. Cereospinal fluid leak (CSF) and meningitis was present in 7(21%) cases using G patch for duroplasty and 2 cases(6%) using fascia lata for duroplasty. Conclusions: The ACM type I can vary in presentation throughout in different age groups, Suboccipital decompression and duroplasty in selected cases are effective treatment for most patients with Chiari I malformations.