Cargando…
Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies
Revision surgery after posterior fossa decompression for Chiari malformation is not uncommon and poses both strategic and technical challenges. We conducted a single-center retrospective cohort study including all adult patients who underwent revision surgery after posterior fossa decompression for...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224814/ https://www.ncbi.nlm.nih.gov/pubmed/35743405 http://dx.doi.org/10.3390/jcm11123334 |
_version_ | 1784733461090664448 |
---|---|
author | Knafo, Steven Malcoci, Mihai Morar, Silvia Parker, Fabrice Aghakhani, Nozar |
author_facet | Knafo, Steven Malcoci, Mihai Morar, Silvia Parker, Fabrice Aghakhani, Nozar |
author_sort | Knafo, Steven |
collection | PubMed |
description | Revision surgery after posterior fossa decompression for Chiari malformation is not uncommon and poses both strategic and technical challenges. We conducted a single-center retrospective cohort study including all adult patients who underwent revision surgery after posterior fossa decompression for Chiari type I malformation between 2010 and 2019. Among 311 consecutive patients operated on for Chiari malformation at our institution, 35 patients had a least one revision surgery with a mean follow-up of 70.2 months. Mean delay for revision was 28.8 months. First revision surgery was performed at the level of the foramen magnum in 25/35 cases and consisted in duraplasty revision in all cases, arachnolysis (51.4%), additional bone decompression (37.1%), tonsillar coagulation or resection (25.7%), 4th ventricle to cervical subarachnoid spaces shunt (5.7%). Most repeat revisions consisted in CSF diversion procedures, with either ventriculo-peritoneal or syringo-peritoneal shunts. Mean number of interventions per patient was 3.2, with 22.9% of patients undergoing 4 or more surgeries. Based on our experience, we propose that revision at the level of the foramen magnum should be considered as a first-line strategy for Chiari decompression failure. Shunting procedures can be performed in case of extensive arachnoiditis or repeated failures. |
format | Online Article Text |
id | pubmed-9224814 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-92248142022-06-24 Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies Knafo, Steven Malcoci, Mihai Morar, Silvia Parker, Fabrice Aghakhani, Nozar J Clin Med Article Revision surgery after posterior fossa decompression for Chiari malformation is not uncommon and poses both strategic and technical challenges. We conducted a single-center retrospective cohort study including all adult patients who underwent revision surgery after posterior fossa decompression for Chiari type I malformation between 2010 and 2019. Among 311 consecutive patients operated on for Chiari malformation at our institution, 35 patients had a least one revision surgery with a mean follow-up of 70.2 months. Mean delay for revision was 28.8 months. First revision surgery was performed at the level of the foramen magnum in 25/35 cases and consisted in duraplasty revision in all cases, arachnolysis (51.4%), additional bone decompression (37.1%), tonsillar coagulation or resection (25.7%), 4th ventricle to cervical subarachnoid spaces shunt (5.7%). Most repeat revisions consisted in CSF diversion procedures, with either ventriculo-peritoneal or syringo-peritoneal shunts. Mean number of interventions per patient was 3.2, with 22.9% of patients undergoing 4 or more surgeries. Based on our experience, we propose that revision at the level of the foramen magnum should be considered as a first-line strategy for Chiari decompression failure. Shunting procedures can be performed in case of extensive arachnoiditis or repeated failures. MDPI 2022-06-10 /pmc/articles/PMC9224814/ /pubmed/35743405 http://dx.doi.org/10.3390/jcm11123334 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Knafo, Steven Malcoci, Mihai Morar, Silvia Parker, Fabrice Aghakhani, Nozar Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies |
title | Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies |
title_full | Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies |
title_fullStr | Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies |
title_full_unstemmed | Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies |
title_short | Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies |
title_sort | surgical management after chiari decompression failure: craniovertebral junction revision versus shunting strategies |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224814/ https://www.ncbi.nlm.nih.gov/pubmed/35743405 http://dx.doi.org/10.3390/jcm11123334 |
work_keys_str_mv | AT knafosteven surgicalmanagementafterchiaridecompressionfailurecraniovertebraljunctionrevisionversusshuntingstrategies AT malcocimihai surgicalmanagementafterchiaridecompressionfailurecraniovertebraljunctionrevisionversusshuntingstrategies AT morarsilvia surgicalmanagementafterchiaridecompressionfailurecraniovertebraljunctionrevisionversusshuntingstrategies AT parkerfabrice surgicalmanagementafterchiaridecompressionfailurecraniovertebraljunctionrevisionversusshuntingstrategies AT aghakhaninozar surgicalmanagementafterchiaridecompressionfailurecraniovertebraljunctionrevisionversusshuntingstrategies |