Chiari I malformation associated with syringomyelia: a retrospective study of 316 surgically treated patients.
Objectives:The objective of this article is to probe the surgical procedures of treatment for Chiari I malformation (CMI) associated with syringomyelia and evaluate their efficacy based on clinical and neuroradiological results.Study design:Retrospective study.Setting:Department of Neurosurgery in Qilu Hospital of Shandong University in China.Methods:We retrospectively reviewed 316 surgically treated patients with CMI. We classified our patients after surgery in four global outcome categories as follows: very good (complete remission or marked improvement), good (slight improvement), fair (stability), poor (slight or marked deterioration). We simply describe the postoperative diameter of the syrinx (collapse, decreased, unchanged or increased).Results:At the time of discharge, the result was very good in 163 cases (51.58%), good in 92 cases (29.11%), fair in 49 cases (15.51%) and poor in 12 cases (3.80%). In the follow-up period, neurological status improved and was then sustained in 94.49% of patients (206/218). At more than 2 years after surgery, we were able to compare pre- and postoperative MR images in 218 patients. A collapse of the syrinx was seen in 34.86% (76/218) of patients. The size of the syrinx was decreased in 31.65% (69/218) of patients, remained unchanged in 26.15% (57/218) of patients and increased in 7.34%(16/218) of patients.Conclusion:Patients with CMI should be treated using various surgical procedures according to different magnetic resonance imaging types; surgical treatments may fully decompress the medulla oblongata and ameliorate the clinical syndromes.Spinal Cord advance online publication, 20 November 2007; doi:10.1038/sj.sc.3102141.
The above is a newly published research article which went back and looked at patients with chiari and syringomyelia who had a posterior fossa decompression performed. This study is from China.
The results are very encouraging and I thought I would share what I thought was good news. I have included the abstract above but the bottom line is very good results were acheived in 52% of patients, good in 29%, fair in 16% and only 4% of patients reported a poor outcome. I see this as positive news.
MRI imaging was done 2 years post-op and compared to pre-operative imaging done. A complete collapse of the syrinx was seen in 35% of patients, a decrease in size in 32%, unchanged size in 26% and an increase in size in 7%.
Although there are no guarantees that a PFD will effect your syrinx I think this and many other research studies prove that odds are it will have a positive effect and that herniated cerebellar tonsils do create a blockage in the proper flow of CSF leading to a syrinx. When the blockage is removed (by removing a portion of the skull) and the CSF flows freely again the syrinx decompresses or shrinks in most cases. I think this adds more weight to the arguement that if at all possible the CAUSE of the syrinx needs to be addressed.
I for one am looking for all the outcome studies I can find. When it comes to chiari and syringomyelia, any outcome studies are extremely rare. They are also so important for us all to have when we are weighing surgical pros and cons in our minds. This study is a nice piece of positive news about the benefits of surgery in regards to syringomyelia. I hope there are many more outcome studies to come in these areas for all of our sakes.
I will once again add that this is just my personal opinions and interpretation of this research paper. I am not an expert and these are only my thoughts and views on the topic. Here is the link to the abstract http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSear