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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...

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Autores principales: Knafo, Steven, Malcoci, Mihai, Morar, Silvia, Parker, Fabrice, Aghakhani, Nozar
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
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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.
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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
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