Rajendra Shrestha*, Rajiv Jha and Prakash Bista
Department of Neurosurgery, NAMS, Bir Hospital, National Trauma Centre, NepalFulltext PDF
Introduction: Chiari malformations are one of the most controversial topics in neurosurgery today.
It is a congenital disorder characterized by the anatomical defect of the base of skull with caudal
displacement of cerebellar tonsils, through the foramen magnum. The objective of the present
series was to study clinical outcome following posterior fossa decompression, C1 laminectomy and
duraplasty in type 1 Arnold Chiari malformation.
Material and Methods: This study was retrospectively analysis of the Chiari I malformation in the
Department of Neurosurgery, NAMS from January 2014 to February 2020. There were 43 admitted
patients with Chiari I malformation in our center. OPD follow up or telephonic questionnaires were
used to analyze and compare the improvement in neck pain and disability before and after surgery.
Results: The most common age group of presentation was 2nd decade (30.3%) followed by 3rd decade
(30.6%). The male to female ratio was 2.5:1. The age ranged from 5 years to 60 years with median age
of 32. Out of them 31 (72%) were females and 12 (28%) were male. The most common presenting
complaint was sensory disturbances 26 patients (61%) followed by neck pain in 17 patients (39%).
The most common sign was limb weakness in 25 patients (58%). All patients were operated with
foramen magnum decompression with duraplasty, subarachnoid dissection of CSF flow and C1
laminectomy except three patients who were undergoing foramen magnum decompression only.
Two patients were cervical unstable after operation. One patient was managed with occipitoatlanto-
axial fixation. We had mortality one which had cervical unstable and chest infection post
operatively. There was one patient with surgical site infection requiring debridement and secondary
suturing. Patients showed an overall clinical improvement of 90%. There were no motor aggravation
occurred in our study. Foramen magnum decompression with duraplasty, subarachnoid dissection
of CSF flow and resection of the C1 posterior arch were found to be associated with favorable results
on clinical signs and symptoms.
Conclusion: Proper patient selection is critical to prevent unnecessary complication and
maximize the outcome. The surgical gold standard consists in three key steps-Foramen magnum
decompressions with duraplasty, subarachnoid dissection of CSF flow and C1 laminectomy.
Arnold Chiari malformation; Decompression; Duraplasty
Shrestha R, Jha R, Bista P. Chiari Malformation-I at Tertiary Center. World J Surg Surgical Res. 2020; 3: 1238..