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1.
Rev Med Suisse ; 16(680): 278-281, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022495

RESUMO

Neuropathic arthropathy is a pathology involving both upper and lower limbs. Different neurological diseases can cause this arthropathy. For instance, shoulder Charcot arthropathies are mostly associated to syringomyelia. The initial diagnosis of this arthropathy is difficult and often delayed in the presence of usually non specific symptoms. Since articular destruction is present in this disease, early diagnosis and primary management of the neurological condition is important, as it slows down the destruction of the joint.


Assuntos
Artrodese , Artropatia Neurogênica/patologia , Artropatia Neurogênica/cirurgia , Celulite (Flegmão) , Artropatia Neurogênica/complicações , Celulite (Flegmão)/complicações , Humanos , Siringomielia/complicações
2.
World Neurosurg ; 135: 241-244, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881343

RESUMO

BACKGROUND: To the best of our knowledge, the presence of Chiari formation and Hirayama disease in the same patient has not been previously reported. On the basis of the presented case, we have attempted to identify the common pathogenesis of both of these clinical entities. CASE DESCRIPTION: We have reported a case of a 23-year-old male patient who had presented with complaints of pain in the nape of neck and shoulders of 9 months' duration, weakness and stiffness in all 4 limbs, and wasting and weakness of muscles of both hands of 6 months' duration. The investigations showed Chiari formation and syringomyelia. Additional investigations depicted the characteristic radiological features associated with Hirayama disease. The patient was treated by atlantoaxial and multisegmental subaxial cervical spinal fixation. CONCLUSIONS: Spinal instability seems to be the nodal point of the pathogenesis of both Chiari formation and Hirayama disease.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Atrofias Musculares Espinais da Infância/diagnóstico por imagem , Siringomielia/diagnóstico por imagem , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Masculino , Fusão Vertebral , Atrofias Musculares Espinais da Infância/complicações , Atrofias Musculares Espinais da Infância/cirurgia , Siringomielia/complicações , Siringomielia/cirurgia , Adulto Jovem
3.
Spine (Phila Pa 1976) ; 44(23): 1653-1660, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31730571

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To compare syrinx characteristics, scoliotic parameters, and neurological deficits between Chiari I malformation (CIM) and idiopathic syringomyelia (IS) in the scoliotic population. SUMMARY OF BACKGROUND DATA: CIM and IS are common in neuromuscular scoliosis patients; however, differences in syrinx characteristics, scoliotic parameters, and neurological deficits between CIM and IS are unclear. METHODS: Thirty-six patients with scoliosis secondary to CIM were enrolled retrospectively and matched with 36 IS patients for sex, age, scoliosis classification, and Cobb angle. Information on radiographic features of scoliosis and syrinx and neurological deficits was systematically collected. RESULTS: Sex, age, and coronal, and sagittal scoliosis parameters did not differ between the CIM and IS groups. The CIM group had a longer syrinx (12.9 ±â€Š4.0 vertebral levels vs. 8.7 ±â€Š5.5 vertebral levels, P < 0.001), a higher cranial extent (3.6 ±â€Š2.2 vs. 5.2 ±â€Š3.5, P = 0.027), and a lower caudal extent (15.6 ±â€Š2.9 vs. 13.0 ±â€Š4.6, P = 0.006) than the IS group, despite no differences in syrinx/cord (S/C) ratio or syrinx classification. No differences in neurological deficits were identified between the CIM and IS patients. CONCLUSION: With demographic and scoliotic coronal parameters matched, the CIM patients had a longer syrinx, located at a higher cranial and lower caudal level, compared with the IS group. No significant differences in syrinx S/C ratio, sagittal features of scoliosis, or neurological deficits were detected between the two groups. LEVEL OF EVIDENCE: 3.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Escoliose/diagnóstico por imagem , Siringomielia/diagnóstico por imagem , Adolescente , Adulto , Malformação de Arnold-Chiari/complicações , Criança , Estudos Transversais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Escoliose/etiologia , Siringomielia/complicações , Vértebras Torácicas/diagnóstico por imagem , Adulto Jovem
4.
World Neurosurg ; 132: 135-137, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479793

RESUMO

We report a case of headache due to a hydrocephalus with associated syringomyelia. Magnetic resonance imaging showed a fourth ventricular outlet obstruction. An endoscopic third ventriculostomy (ETV) was performed with successful clinical and radiologic outcome. Fourth ventricular outlet obstruction is an uncommon cause of obstructive hydrocephalus, but it must be kept in mind. As far as we know, there are few reports that propose ETV as treatment. Therefore our case supports that ETV could be a successful option for the management of this condition.


Assuntos
Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adulto , Feminino , Cefaleia/etiologia , Humanos , Hidrocefalia/etiologia , Siringomielia/complicações , Siringomielia/cirurgia , Resultado do Tratamento
6.
BMC Neurol ; 19(1): 189, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395022

RESUMO

BACKGROUND: Lumbosacral lipomas (LLs) may remain asymptomatic or lead to progressive neurological deterioration. However, sudden neurological deterioration is a rare and severe event. Herein, we report rare occurrences of sudden clinical deterioration in two previously asymptomatic children harbouring intradural LLs without dermal sinus tracts or signs of occult dysraphism. A review of the pertinent literature is also included. CASE PRESENTATION: One child exhibited acute deterioration because of an epidural abscess associated with a filar lipoma without a sinus tract (probably caused by haematogenous spreading from a respiratory tract multiple infection), and the other child exhibited acute deterioration because of a very large, holocord syringomyelia-like cyst associated with a small conus lipoma. Both patients were 4 years old. In case #2, a previously undetected, severe tethered cord (conus at the S3-S4 level) was also present. A complete recovery was attained after an urgent surgical operation in both cases (in addition to targeted antibiotic therapy in case #1). All cases of deterioration in the literature were caused by abscess formation in dermal sinus tracts. CONCLUSIONS: Prophylactic surgery may be indicated even in asymptomatic children that have tethered cord and surgically favourable LLs (small dorsal and filar LLs), especially if the conditions are associated with progressive syringomyelia. Similarly, intradural dermal sinus tracts should be regarded as surgery-indicated, even if the conus is in its normal position and the patient is asymptomatic because there is a consistent risk of severe, infection-related complications. Finally, asymptomatic patients with filar LLs and a normally located conus can be candidates for surgery or an accurate clinical and radiological follow-up.


Assuntos
Lipoma/patologia , Neoplasias da Medula Espinal/patologia , Pré-Escolar , Humanos , Lipoma/complicações , Imagem por Ressonância Magnética , Masculino , Espinha Bífida Oculta/complicações , Neoplasias da Medula Espinal/complicações , Siringomielia/complicações
7.
World Neurosurg ; 130: 432-438, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31351204

RESUMO

BACKGROUND: The natural course of syringomyelia is unpredictable. Only a few cases of adults with spontaneous resolution of syringomyelia associated with Chiari malformation type I (CM-I) have been reported. The timing of surgical intervention for syringomyelia remains controversial. The present report has documented a case with the longest medical history of syringomyelia reported, the associated imaging findings over 16 years, the mild symptom progression after the spontaneous resolution of syringomyelia, and a review of the relevant reported data. The natural history of our patient provides a unique view regarding the factors that might lead to the development and spontaneous resolution of syringomyelia. CASE DESCRIPTION: We present the case of a 36-year-old woman who had been monitored for 16 years for mild symptomatic CM-I and syringomyelia. After regular follow-up examinations for the initial 10 years, magnetic resonance imaging revealed partial spontaneous resolution of the syringomyelia and unchanged symptoms. However, after 6 additional years of follow-up examinations, her symptoms had mildly progressed, and the size of the syringomyelia had obviously decreased. CONCLUSIONS: The findings from our patient suggest that the natural course of mild symptomatic CM-I in adult patients will be benign and nonprogressive. Patients will commonly present with very few or mild symptoms, despite the presence of a large syrinx. It would be reasonable to observe patients with similar mild symptoms and syringomyelia. Surgery will be indicated by the type, severity, and duration of symptoms at the first clinical visit. Periodic follow-up examinations are also essential after spontaneous resolution because the pathophysiology of syringomyelia is incompletely understood and recurrence possible.


Assuntos
Siringomielia/patologia , Adulto , Assistência ao Convalescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Remissão Espontânea , Siringomielia/complicações
8.
J Med Case Rep ; 13(1): 222, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31325957

RESUMO

BACKGROUND: Management of the disproportionately large communicating fourth ventricle is still problematic. CASE PRESENTATION: Two cases of disproportionately large communicating fourth ventricle were treated successfully. One was a case of a 51-year-old Han Chinese woman with a complaint of headache and dizziness of 1 year's duration. Magnetic resonance imaging (MRI) demonstrated hydrocephalus with a disproportionately large fourth ventricle. She underwent a ventriculo-peritoneal shunt of the right lateral ventricle. Her symptoms were relieved totally. Five years later, magnetic resonance imaging showed she had a normal ventricular system. The other case was a 24-year-old Han Chinese man with a 2-month history of headache and dizziness accompanied by progressive loss of bilateral vision. Magnetic resonance imaging revealed hydrocephalus with a disproportionately large fourth ventricle, crowded posterior cranial fossa, and syringomyelia extending from C1 to C5. He underwent suboccipital and C1 decompression and duraplasty. Shortly after the surgery, his symptoms were relieved completely, the syringomyelia completely disappeared, and the fourth ventricle became significantly smaller. CONCLUSIONS: The management of the disproportionately large communicating fourth ventricle should be individualized. If it coexists with crowded posterior cranial fossa or syringomyelia, posterior fossa decompression could be an option for initial management. If there is no sign of crowded posterior cranial fossa or syringomyelia, shunt of the lateral ventricles might be the first choice.


Assuntos
Quarto Ventrículo/patologia , Hidrocefalia/etiologia , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Tontura/etiologia , Feminino , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Cefaleia/etiologia , Humanos , Hidrocefalia/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Siringomielia/patologia , Resultado do Tratamento , Derivação Ventriculoperitoneal , Adulto Jovem
9.
A A Pract ; 12(11): 393-395, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31162165

RESUMO

Currarino triad is a rare hereditary condition characterized by anorectal malformation, sacral dysgenesis, and a presacral mass. Neuraxial anesthetic techniques pose increased risks to patients with spinal malformations. Ultrasound imaging improves accuracy of intervertebral level identification compared to clinical estimation. We present the case of a parturient with Currarino triad and a low conus medullaris undergoing cesarean delivery where preprocedural magnetic resonance imaging and ultrasound imaging allowed for successful combined spinal-epidural anesthesia to be performed. Despite these measures, however, the patient did develop a high spinal and temporary postoperative dizziness.


Assuntos
Canal Anal/anormalidades , Anestesia Epidural/métodos , Raquianestesia/métodos , Anormalidades do Sistema Digestório/complicações , Reto/anormalidades , Sacro/anormalidades , Siringomielia/complicações , Adulto , Cesárea , Feminino , Humanos , Imagem por Ressonância Magnética , Gravidez , Ultrassonografia
10.
World Neurosurg ; 128: 501-505, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077896

RESUMO

BACKGROUND: Chiari malformation results from a bony structural anomaly of the skull base. The structural defect causes downward displacement of the cerebellar tonsils through the foramen magnum. The herniated tonsils block the normal flow of cerebrospinal fluid, which causes a wide spectrum of clinical symptoms. CASE REPORT: In May 2015, a 16-year-old girl was referred to our center because of a 1-year history of occipital headache, most often triggered by exercise and physical activity at school. She had experienced new-onset numbness in both hands, more severe on the right side, associated with some degrees of weakness. Eventually, an evaluation of her condition included magnetic resonance imaging in T1 and T2 sequences, which revealed a 20-mm downward migration of the cerebellar tonsils, associated with a cervical cord syrinx at the level of the fourth and fifth cervical vertebrae. The patient underwent posterior fossa decompression and C1 and partial C2 laminectomies. Postoperatively there were no complications, and the patient was discharged on day 3. Postoperatively, she experienced some improvement in her symptoms. After 2 months of routine outpatient follow-up, she was better, the headaches had subsided, she could resume some activities, and there was no paresis in her limbs. CONCLUSIONS: In cases of progressive symptoms of Chiari malformation, surgical decompression is important and should be considered after shunt insertion to the hindbrain.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Cerebelo/cirurgia , Complicações Pós-Operatórias/cirurgia , Adolescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Siringomielia/complicações , Siringomielia/diagnóstico por imagem
11.
Medicine (Baltimore) ; 98(12): e14804, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30896624

RESUMO

RATIONALE: The purpose of this study is to introduce the application of screw view model of navigation (SVMN) for adolescent idiopathic scoliosis (AIS). It is a challenge to insert pedicle screw into the vertebral body of scoliosis, and the misplaced screw may lead to neurovascular injury. In order to minimize surgical complications, we used a novel method of SVMN technology to facilitate pedicle screw insertion. PATIENT CONCERNS: Her mother brought her to our outpatient department upon noticing the girl's different heights of shoulders and unbalance of the trunk. DIAGNOSES: She was diagnosed with AIS and syringomyelia. INTERVENTIONS: We used an SVMN technology to assist pedicle screw insertion and correction surgery in this 20-year-old patient. OUTCOMES: This study indicates that the SVMN could obtain a satisfactory surgical effect for AIS. The Cobb angle of segmental scoliosis (T7-L2) was 55° before surgery, and 3.5° after surgery, and the rate of correction was 93.6%. The segmental kyphosis (T7-L1) was 56.8° preoperatively and 32° postoperatively with the rate of correction of 43.6%. The distance between the center sacral vertical line (CSVL) and the C7 plumb line (CPL) was reduced from 56.2 mm to 0.2 mm, and the sagittal imbalance of 35.8 mm was improved to 3.5 mm. In addition, the misplacement of pedicle screws, the volume of blood loss, the operation time, and surgical complications were also recorded. The follow-up duration was 33 months. LESSONS: The utilization of SVMN in AIS might reduce the incidence of screw misplacement and avoid neurovascular damage, as well as a satisfactory correction. The application of SVMN for AIS is an efficacious and safe method.


Assuntos
Parafusos Pediculares , Escoliose/complicações , Escoliose/cirurgia , Cirurgia Assistida por Computador/métodos , Siringomielia/complicações , Perda Sanguínea Cirúrgica , Feminino , Humanos , Duração da Cirurgia , Complicações Pós-Operatórias , Adulto Jovem
14.
J Int Med Res ; 47(4): 1771-1777, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30799663

RESUMO

Dandy-Walker syndrome associated with syringomyelia is a rare condition, with few reports of adult cases. We describe an adult case of Dandy-Walker syndrome with concomitant syringomyelia. A 33-year-old man presented with a 3-month history of walking instability, numbness in the hands, memory deterioration, and urinary incontinence. A physical examination showed a positive Romberg sign. Brain computed tomography and magnetic resonance imaging showed hydrocephalus, a cyst in the posterior fossa, absence of the cerebellar vermis, hypoplasia of the corpus callosum and cerebella, and syringomyelia. All of these symptoms were consistent with the diagnosis of Dandy-Walker syndrome. Surgery involving arachnoid adhesiolysis and endoscopic third ventriculostomy was performed. At the 6-month follow-up, the symptoms were completely relieved. Magnetic resonance imaging showed that syringomyelia was greatly reduced and the hydrocephalus remained unchanged. Dandy-Walker syndrome with concomitant syringomyelia in adults is exceedingly rare. Early diagnosis and appropriate surgical treatment of this condition should be highlighted. Combined arachnoid adhesiolysis and endoscopic third ventriculostomy may be an effective approach.


Assuntos
Síndrome de Dandy-Walker/patologia , Siringomielia/patologia , Adulto , Síndrome de Dandy-Walker/complicações , Síndrome de Dandy-Walker/cirurgia , Humanos , Masculino , Prognóstico , Siringomielia/complicações , Siringomielia/cirurgia
15.
Medicine (Baltimore) ; 98(5): e14353, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702626

RESUMO

RATIONALE: Bronchogenic cysts refer to congenital anomalies derived from the primitive foregut. Spinal bronchogenic cysts are uncommon entities, and those occurring in the intramedullary sites are extremely rare. Bronchogenic cysts involving the foramen magnum region have only been described in 2 cases; however, intramedullary bronchogenic cysts with syringomyelia have not yet been reported. PATIENT CONCERNS: A 46-year-old woman presented with a 6-month history of pain in the posterior neck region and a 1-month history of numbness in the upper extremities. Neurological examination revealed a loss of sensation in bilateral upper extremities and sensory dissociation. Magnetic resonance imaging (MRI) showed an intramedullary cystic lesion in the foramen magnum region and syringomyelia. DIAGNOSIS: Histopathological findings were consistent with a bronchogenic cyst. INTERVENTIONS AND OUTCOMES: A surgical resection of the cystic lesion was performed via a posterior midline approach. Under neurophysiological monitoring, the cyst was punctured, yielding gelatinous liquid. The dorsal part of the cystic wall was removed. One month postoperatively, the symptoms were resolved completely. Three months after operation, MRI showed no recurrence of the cyst and the syringomyelia disappeared. LESSONS: Intramedullary bronchogenic cysts with syringomyelia are extremely rare. Preoperative identification is challenging and definitive diagnosis depends on histopathological evidence. Timely surgical resection should be highlighted.


Assuntos
Cisto Broncogênico/complicações , Cisto Broncogênico/diagnóstico , Forame Magno , Siringomielia/complicações , Siringomielia/diagnóstico , Cisto Broncogênico/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Siringomielia/cirurgia
16.
World Neurosurg ; 125: e937-e946, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30763740

RESUMO

OBJECTIVE: Immediate postoperative and early clinical outcome of treatment of spinal kyphoscoliosis (SKS) associated with Chiari formation (CF) and syringomyelia (SM) and treated by atlantoaxial fixation is described. METHODS: During the period April 2016 to March 2018, 11 patients with SKS as a major presenting symptom in association with CF and SM were surgically treated and are analyzed retrospectively. The patients were 6 boys and 5 girls, and their ages ranged from 11-17 years (average 14 years). Six patients (54.5%) had associated neurologic symptoms and 9 patients had neck pain. All patients were treated by atlantoaxial fixation. No manipulation of foramen magnum bone or dura was performed. No surgery was performed on the subaxial cervical or dorsal spine. Patient Satisfaction Score was based on a specially designed questionnaire. Other outcome measures included clinical and radiologic assessment data, clinical photographs and video observation, and a Scoliosis Research Society Questionnaire. RESULTS: Apart from improvement in neurologic condition, more particularly in breathing capability and voice volume restoration, all patients and their relatives noticed recovery in SKS in the immediate postoperative phase. During the average follow-up of 14 months, all patients continued to have progressive symptomatic recovery and recovery from SKS. Patient Satisfaction Score suggested that all patients were 'highly' satisfied with the surgical outcome. CONCLUSIONS: Atlantoaxial fixation in patients with CF and SM associated with SKS results in reversal of several musculoskeletal and neural abnormalities that includes recovery from spinal deformity.


Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia , Articulação Atlantoaxial/cirurgia , Cifose/cirurgia , Fusão Vertebral/métodos , Siringomielia/complicações , Siringomielia/cirurgia , Adolescente , Criança , Feminino , Humanos , Cifose/etiologia , Masculino , Escoliose/etiologia , Escoliose/cirurgia , Resultado do Tratamento
17.
Acta Neurochir Suppl ; 125: 97-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610308

RESUMO

Chiari malformation type I (CM-I), or hindbrain herniation syndrome, has traditionally been defined as a dislocation of the cerebellar tonsils 5 mm or more below the foramen magnum on sagittal magnetic resonance imaging (MRI) [1, 2]. An association of this anomaly with syringomyelia is observed in 45-68% of patients [3, 4].


Assuntos
Aracnoide-Máter/fisiopatologia , Malformação de Arnold-Chiari/fisiopatologia , Forame Magno/fisiopatologia , Siringomielia/fisiopatologia , Malformação de Arnold-Chiari/complicações , Humanos , Siringomielia/complicações
18.
Acta Neurochir Suppl ; 125: 101-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610309

RESUMO

AIM: In this paper we evaluate the role of atlantoaxial instability in the pathogenesis of Chiari formation type I and the role of atlantoaxial stabilization for treatment of this condition in cases with no obvious bone malformation in the region of the craniovertebral junction. MATERIALS, METHODS AND RESULTS: During the period from January 2010 to July 2016, we identified 57 cases of Chiari formation where there was no bone malformation or evidence of craniovertebral junction instability that could be diagnosed on the basis of an abnormal increase in the atlantodental interval on dynamic imaging. Forty-eight of these patients had syringomyelia. The average duration of follow-up was 42 months. There were 30 males and 27 females in the series. The ages of the patients ranged from 4 to 57 years. The Japanese Orthopaedic Association (JOA), visual analogue scale (VAS) and Goel clinical grading systems were used to assess the patients' clinical status. Atlantoaxial instability was diagnosed on the basis of vertical mobility of the odontoid process on dynamic radiographs, facetal malalignment on imaging or direct bone handling during the surgical procedure. Surgical treatment was achieved using atlantoaxial fixation. Foramen magnum decompression or syrinx manipulation was not done. All patients had immediate postoperative and sustained clinical symptomatic recovery. A reduction in the size of the syrinx was observed in ten patients and regression of tonsillar herniation was observed in 12 of 23 cases in which postoperative magnetic resonance imaging (MRI) was possible. CONCLUSION: Atlantoaxial instability is the prime factor in the genesis of Chiari formation even when there is no bone abnormality in the craniovertebral junction.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Articulação Atlantoaxial/cirurgia , Instabilidade Articular/cirurgia , Fusão Vertebral/métodos , Siringomielia/cirurgia , Adolescente , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Articulação Atlantoaxial/diagnóstico por imagem , Criança , Pré-Escolar , Descompressão Cirúrgica , Feminino , Forame Magno/diagnóstico por imagem , Forame Magno/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
19.
Acta Neurochir Suppl ; 125: 125-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610312

RESUMO

BACKGROUND: The variety of symptoms and radiological findings in patients with Chiari malformation type I makes both the indication for surgery and the technical modality controversial. We report our 5-year experience, describing our technique and critically evaluating the clinical results. METHODS: Between 2012 and 2016, 25 patients (15 female and 10 male; mean age 39.2 years) underwent posterior fossa decompression for Chiari malformation type I. Their clinical complaints included headache, nuchalgia, upper limb weakness or numbness, instability, dizziness and diplopia. Syringomyelia was present in 12 patients (48%). Suboccipital craniectomy was completed in all cases with C1 laminectomy and shrinkage of the cerebellar tonsils by bipolar coagulation; duraplasty was performed with a suturable dura substitute. RESULTS: Gratifying results were observed in our series. Symptoms and signs were resolved in 52% of patients, and 20% of patients had an improvement in their preoperative deficits. The symptoms of six patients (24%) were essentially unchanged, and one patient (4%) deteriorated despite undergoing surgery. Generally, patients with syringomyelia on magnetic resonance imaging (MRI) showed less symptomatic improvement after surgery. The syrinx disappeared in seven of 12 patients, and complications occurred in three patients (12%). CONCLUSION: Cerebellar tonsil reduction and restoration of cerebrospinal fluid (CSF) circulation provided clinical improvement and a stable reduction in the syrinx size in the vast majority of treated patients, with a low rate of complications.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Vermis Cerebelar/cirurgia , Adulto , Malformação de Arnold-Chiari/complicações , Descompressão Cirúrgica , Craniectomia Descompressiva , Eletrocoagulação , Feminino , Humanos , Laminectomia , Imagem por Ressonância Magnética , Masculino , Siringomielia/complicações , Resultado do Tratamento
20.
Acta Neurochir Suppl ; 125: 133-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610313

RESUMO

BACKGROUND: Posterior fossa decompression with expansive duraplasty is the first-line surgical approach for the treatment of symptomatic syringomyelia associated with Chiari malformation. Despite good decompression, the clinical failure rate is reported to be up to 26%. A syringosubarachnoid (S-S) shunt may be used as a secondary option. METHODS: In this paper we describe a single-institution experience of three cases of holocord syringomyelia-Chiari complex treated with foramen magnum decompression, expansive duraplasty and an S-S shunt carried out in a single-stage single approach. Following a standard suboccipital craniectomy, patients were submitted to syrinx fenestration and simultaneous insertion of an S-S shunt through a 1-mm posterior midline myelotomy at the C2 level prior to expansive dural reconstruction. RESULTS: Postoperative imaging showed immediate reduction of the holocord cavities. Preoperative neurological deficits rapidly improved significantly and were stabilized at follow-up. CONCLUSION: In our experience the positioning of the shunt catheter at a high level of the spinal cord (C2) did not add a significant risk of morbidity and obviated the need for a second operation and/or a separate incision in cases of clinical failure. This technique avoided the risk associated with a second surgery and its morbidity, and allowed prompt clinical recovery.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Derivações do Líquido Cefalorraquidiano/métodos , Craniectomia Descompressiva/métodos , Siringomielia/cirurgia , Malformação de Arnold-Chiari/complicações , Forame Magno/cirurgia , Humanos , Espaço Subaracnóideo/cirurgia , Siringomielia/complicações
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