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Surgical Decision Management in Chiari Type 2 Malformation: Single Center Experience

Year 2017, Volume: 14 Issue: 3, 101 - 105, 01.07.2017

Abstract

Aim: Chiari malformation type II CM-II is frequent with meningomyelocele MMC . We aim to present the accurate timing and indications and to reveal the necessity of the CM-II surgery.Materials & Methods: This was a prospective and observational study which involved 25 patients 9 infants operated, 16 infants non-operated . Spinal and cranial MRI examinations were performed on all infants. MMC, CM-II and hydrocephalus of infants were evaluated clinically and radiologically. The operation decision was made for infants who had symptoms of apnea, nourishment, respiratory distress, persistent vomiting and progressive weakness in the upper extremity, and these symptoms were associated with CM-II malformation. The follow-up decision was made independently of the MRIs that did not show these symptoms. Clinical, surgical management and long-term outcomes were compared for both groups.Results: 25 infants were included, 14 of them were male. 9 MMC baby was performed during neonatal period due to symptomatic CM-II, while 16 babies were followed up for CM-II after MMC repair. Mean duration of follow-up for operated infants was 31.0 ± 16.9 and non-operated group was 31.3 ± 9.9.Comparing the lowest border of downward herniated cerebellar tonsil levels for CM-II cases, the presence of cerebellar tonsils below C3 level was present in 77% of the operated cases and only 37% of the cases without operation p=0.05 . Apnea was the most common symptom in the operated cases.Conclusion: Cerebellar tonsils were located lower in the cervical spinal canal in the operated infants. In the presence of clinical symptoms due to CM-II, MRI findings may be the second step.

References

  • Otera Y, Morokuma S, Fukushima K, Anami A, Yumoto Y, Ito Y ve ark, Neurological outcomes in chiari type II malformations and their correlati- on to morphological findings and fetal heart rate patterns: A retrospective study. BMC Res Notes 2015;8:57.
  • Morota N, Ihara S, Postnatal ascent of the cerebellar tonsils in chiari malformation type II following surgical repair of myelomeningocele. J Neurosurg Pediatr 2008;2:188-193.
  • Salman MS, Posterior fossa decompression and the cerebellum in chiari type II malformation: A preliminary mri study. Childs Nerv Syst 2011;27:457-462.
  • Messing-Junger M, Rohrig A, Primary and secondary management of the chiari II malformation in children with myelomeningocele. Childs Nerv Syst 2013;29:1553-1562.
  • Alsaadi MM, Iqbal SM, Elgamal EA, Gozal D, Sleep-disordered breathing in children with chiari malformation type II and myelomeningocele. Pedi- atr Int 2012;54:623-626.
  • Ogiwara H, Morota N, Surgical decompression without dural opening for symptomatic chiari type II malformation in young infants. Childs Nerv Syst 2013;29:1563-1567.
  • Nishimura T, Mori K, Sada Y, Fujii M, Apneic spells in a patient with mye- lomeningocele without chiari type II malformation--case report. Neurol Med Chir (Tokyo) 1995;35:876-881.
  • Geerdink N, van der Vliet T, Rotteveel JJ, Feuth T, Roeleveld N, Mullaart RA, Essential features of chiari II malformation in mr imaging: An inte- robserver reliability study--part 1. Childs Nerv Syst 2012;28:977-985.
  • James HE, Brant A, Treatment of the chiari malformation with bone de- compression without durotomy in children and young adults. Childs Nerv Syst 2002;18:202-206.

Chiari Tip 2 Malformasyonunda Cerrahi Karar Yönetimi: Tek Merkez Deneyimi

Year 2017, Volume: 14 Issue: 3, 101 - 105, 01.07.2017

Abstract

Amaç: Chiari Tip II malformasyonu CM-II meningomiyelosel MMC ile sık birliktelik göstermektedir. Bu araştırmada; CM –II li olgularda operasyon için doğru zamanın tayini ve operasyon için endikasyonları araştırmayı hedefledik.Gereç ve Yöntemler: Çalışma prospektif ve gözlemsel olup; MMC nedeni ile yenidoğan yoğun bakım ünitesine yatan 25 bebek dahil edildi. Tüm bebeklere tüm spinal ve kranial MRG tetkikleri yapıldı. Bebeklerin MMC, CM-II ve hidrosefalileri klinik ve radyolojik olarak değerlendirildi. Apne, beslenememe, solunum sıkıntısı, inatçı kusmalar ve üst ekstremitede ilerleyici güçsüzlük semptomları olan ve bu semptomları CM-II malformasyonu ile ilişkilendirilen bebekler için operasyon kararı verildi. Bu semptomları göstermeyen olgular MRG’lerinden bağımsız olarak izlem kararı verildi. Opere edilen ve edilmeyen bebeklerin klinik, cerrahi yönetim ve uzun dönem sonuçları karşılaştırıldı.Bulgular: Çalışmaya; 14’ü erkek olmak üzere 25 bebek dahil edildi. 9 MMC’li bebek semptomatik CM-II’den dolayı yenidoğan döneminde opere edilirken, 16 bebek de MMC tamiri yapıldıktan sonra CM-II açısından izlendi. Opere edilen bebeklerin ortalama izlem süresi 31.0 ± 16.9 olup, opere edilmeyen olguların izlem süresi ise 31.3 ±9.9 idi. Opere edilen ve opere olmadan izlenen CM-II vakalarının herniye olan serebellar tonsil seviyeleri karşılaştırıldığında C3 altı serebellar tonsil varlığı opere edilen olguların % 77’sinde varken, opere edilmeden izlenen olguların yalnızca % 37’sinde mevcuttu p=0.05 . Opere edilen olgularda en sık gözlenen semptom apne olarak saptandı.Sonuç: Cerrahiye alınan hastaların çoğunda serebellar tonsillerin servikal omurilik kanalında daha aşağı yerleşimliydi. CM-II’ye bağlı oluşabilecek klinik semptomlar MRG bulguları ikinci plana alınabilemektedir.

References

  • Otera Y, Morokuma S, Fukushima K, Anami A, Yumoto Y, Ito Y ve ark, Neurological outcomes in chiari type II malformations and their correlati- on to morphological findings and fetal heart rate patterns: A retrospective study. BMC Res Notes 2015;8:57.
  • Morota N, Ihara S, Postnatal ascent of the cerebellar tonsils in chiari malformation type II following surgical repair of myelomeningocele. J Neurosurg Pediatr 2008;2:188-193.
  • Salman MS, Posterior fossa decompression and the cerebellum in chiari type II malformation: A preliminary mri study. Childs Nerv Syst 2011;27:457-462.
  • Messing-Junger M, Rohrig A, Primary and secondary management of the chiari II malformation in children with myelomeningocele. Childs Nerv Syst 2013;29:1553-1562.
  • Alsaadi MM, Iqbal SM, Elgamal EA, Gozal D, Sleep-disordered breathing in children with chiari malformation type II and myelomeningocele. Pedi- atr Int 2012;54:623-626.
  • Ogiwara H, Morota N, Surgical decompression without dural opening for symptomatic chiari type II malformation in young infants. Childs Nerv Syst 2013;29:1563-1567.
  • Nishimura T, Mori K, Sada Y, Fujii M, Apneic spells in a patient with mye- lomeningocele without chiari type II malformation--case report. Neurol Med Chir (Tokyo) 1995;35:876-881.
  • Geerdink N, van der Vliet T, Rotteveel JJ, Feuth T, Roeleveld N, Mullaart RA, Essential features of chiari II malformation in mr imaging: An inte- robserver reliability study--part 1. Childs Nerv Syst 2012;28:977-985.
  • James HE, Brant A, Treatment of the chiari malformation with bone de- compression without durotomy in children and young adults. Childs Nerv Syst 2002;18:202-206.
There are 9 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Senem Alkan Özdemir

Nail Özdemir This is me

Ali Karadağ This is me

Özkan İlhan This is me

Esra Arun Özer This is me

Publication Date July 1, 2017
Published in Issue Year 2017 Volume: 14 Issue: 3

Cite

Vancouver Alkan Özdemir S, Özdemir N, Karadağ A, İlhan Ö, Arun Özer E. Chiari Tip 2 Malformasyonunda Cerrahi Karar Yönetimi: Tek Merkez Deneyimi. JGON. 2017;14(3):101-5.