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Neurosurgical Review

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11-07-2022 | Tonsillectomy | Research

Outcome evaluation of decompression surgery combined with cerebellar tonsillectomy compared without cerebellar tonsillectomy for Chiari type I malformation patients

Authors: Jun Li, Taohui Ouyang, Ping Xu, Xiaofei Huang, Xie Song, Ping Wang, Wei Meng, Jiang Xu, Na Zhang

Published in: Neurosurgical Review | Issue 5/2022

Abstract

Background

Surgical intervention is an important treatment option to improve the prognosis for Chiari type I malformation (CM-I) patients. However, there is no consensus about surgical strategies. The article intends to evaluate the effect of decompression combined with or without cerebellar tonsillectomy in the treatment of CM-I.

Method

Following PRISMA’s principles, Embase, PubMed, Web of Science, and Cochrane databases and references to relevant articles were searched to include only original articles on decompression combined with or without cerebellar tonsillectomy in CM-I patients. Through meta-analysis, the data on clinical improvement, radiological improvement, and complications were pooled.

Results

Nine articles, including 399 CM-I patients undergoing decompression alone and 343 undergoing decompression with cerebellar tonsillectomy, meet the inclusion standard. In comparison, the improvement rate of clinical symptoms or signs in patients with cerebellar tonsillectomy is higher and statistically significant (RR: 0.85, 95% CI: 0.75–0.95; P = 0.006). However, decompression with cerebellar tonsillectomy is also significantly higher in the incidence of postoperative complications (RR: 0.54, 95% CI: 0.36–0.80; P = 0.002). No statistical difference is discovered between the two groups in the improvement rate of syringomyelia (RR: 0.77, 95% CI: 0.57–1.03; P = 0.08).

Conclusions

Although decompression with cerebellar tonsillectomy is superior than decompression alone in clinical improvement for CM-I patients, it also faces a higher risk of postoperative complications. The reduction of syringomyelia in the two groups can be considered equally effective without significant differences. In the future, the results of the research require multicenter and large-scale randomized controlled trials to verify in clinical practice.

Trial registration: CRD42022321750 (PROSPERO).

Antkowiak L, Tabakow P (2021) Comparative assessment of three posterior fossa decompression techniques and evaluation of the evidence supporting the efficacy of syrinx shunting and filum terminale sectioning in Chiari malformation type I. A systematic review and network meta-analysis. World Neurosurg 152:31–43. https://doi.org/10.1016/j.wneu.2021.05.124CrossRefPubMed

Arnautovic A, Splavski B, Boop FA, Arnautovic KI (2015) Pediatric and adult Chiari malformation type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr 15:161–177. https://doi.org/10.3171/2014.10.peds14295CrossRefPubMed

Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B (1998) Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg 88:237–242. https://doi.org/10.3171/jns.1998.88.2.0237CrossRefPubMed

De Vlieger J, Dejaegher J, Van Calenbergh F (2019) Posterior fossa decompression for Chiari malformation type I: clinical and radiological presentation, outcome and complications in a retrospective series of 105 procedures. Acta Neurol Belg 119:245–252. https://doi.org/10.1007/s13760-019-01086-7CrossRefPubMed

Delavari N, Wang AC, Bapuraj JR, Londy F, Muraszko KM, Garton HJL, Maher CO (2020) Intraoperative phase contrast MRI analysis of cerebrospinal fluid velocities during posterior fossa decompression for Chiari I malformation. J Magnetic Resonance Imaging : JMRI 51:1463–1470. https://doi.org/10.1002/jmri.26953CrossRefPubMed

Durham SR, Fjeld-Olenec K (2008) Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr 2:42–49. https://doi.org/10.3171/ped/2008/2/7/042CrossRefPubMed

Fan T, Zhao H, Zhao X, Liang C, Wang Y, Gai Q (2017) Surgical management of Chiari I malformation based on different cerebrospinal fluid flow patterns at the cranial-vertebral junction. Neurosurg Rev 40:663–670. https://doi.org/10.1007/s10143-017-0824-1CrossRefPubMed

Fischer EG (1995) Posterior fossa decompression for Chiari I deformity, including resection of the cerebellar tonsils. Childs Nerv Syst 11:625–629. https://doi.org/10.1007/bf00300718CrossRefPubMed

Flint G (2021) Syringomyelia: diagnosis and management. Pract Neurol 21:403–411. https://doi.org/10.1136/practneurol-2021-002994CrossRefPubMed

10.

Galarza M, Sood S, Ham S (2007) Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Childs Nerv Syst 23:691–696. https://doi.org/10.1007/s00381-007-0297-6CrossRefPubMed

11.

Geng LY, Liu X, Zhang YS, He SX, Huang QJ, Liu Y, Hu XH, Zou YJ, Liu HY (2018) Dura-splitting versus a combined technique for Chiari malformation type I complicated with syringomyelia. Br J Neurosurg 32:479–483. https://doi.org/10.1080/02688697.2018.1498448

12.

Guyotat J, Bret P, Jouanneau E, Ricci AC, Lapras C (1998) Syringomyelia associated with type I Chiari malformation. A 21-year retrospective study on 75 cases treated by foramen magnum decompression with a special emphasis on the value of tonsils resection. Acta Neurochir (Wien) 140:745–754. https://doi.org/10.1007/s007010050175CrossRef

13.

Hoffman H, Bunch KM, Paul T, Krishnamurthy S (2021) Comparison of pericranial autograft and AlloDerm for duraplasty in patients with type I Chiari malformation: retrospective cohort analysis. Oper Neurosur (Hagerstown, Md) 21:386–392. https://doi.org/10.1093/ons/opab343CrossRef

14.

Jia C, Li H, Wu J, Gao K, Zhao CB, Li M, Sun X, Yang B (2019) Comparison decompression by duraplasty or cerebellar tonsillectomy for Chiari malformation-I complicated with syringomyelia. Clin Neurol Neurosurg 176:1–7. https://doi.org/10.1016/j.clineuro.2018.11.008CrossRefPubMed

15.

Kahn EN, Muraszko KM, Maher CO (2015) Prevalence of Chiari I malformation and syringomyelia. Neurosurg Clin N Am 26:501–507. https://doi.org/10.1016/j.nec.2015.06.006CrossRefPubMed

16.

Koueik J, Sandoval-Garcia C, Kestle JRW, Rocque BG, Frim DM, Grant GA, Keating RF, Muh CR, Oakes WJ, Pollack IF, Selden NR, Tubbs RS, Tuite GF, Warf B, Rajamanickam V, Broman AT, Haughton V, Rebsamen S, George TM, Iskandar BJ (2019) Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study. J Neurosurg Pediatr 25:21–29. https://doi.org/10.3171/2019.8.peds19154

17.

Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, Speer MC (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44:1005–1017. https://doi.org/10.1097/00006123-199905000-00042CrossRefPubMed

18.

Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y (1997) Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg 86:40–47. https://doi.org/10.3171/jns.1997.86.1.0040CrossRefPubMed

19.

Osborne-Grinter M, Arora M, Kaliaperumal C, Gallo P (2021) Posterior fossa decompression and duraplasty with and without arachnoid preservation for the treatment of adult Chiari malformation type 1: a systematic review and meta-analysis. World Neurosurg 151:e579–e598. https://doi.org/10.1016/j.wneu.2021.04.082CrossRefPubMed

20.

Phan K, Mobbs RJ (2015) Systematic reviews and meta-analyses in spine surgery, neurosurgery and orthopedics: guidelines for the surgeon scientist. J Spine Surg (Hong Kong) 1:19–27. https://doi.org/10.3978/j.issn.2414-469X.2015.06.01CrossRef

21.

Pueyrredon F, Spaho N, Arroyave I, Vinters H, Lazareff J (2007) Histological findings in cerebellar tonsils of patients with Chiari type I malformation. Childs Nerv Syst 23:427–429. https://doi.org/10.1007/s00381-006-0252-yCrossRefPubMed

22.

Stanko KM, Lee YM, Rios J, Wu A, Sobrinho GW, Weingart JD, Jackson EM, Ahn ES, Chaichana KL, Jallo GI (2016) Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari type I malformation. J Neurosurg Pediatr 17:174–181. https://doi.org/10.3171/2015.6.peds14471CrossRefPubMed

23.

Wan MJ, Nomura H, Tator CH (2008) Conversion to symptomatic Chiari I malformation after minor head or neck trauma. Neurosurgery 63:748–753; discussion 753. https://doi.org/10.1227/01.neu.0000325498.04975.c0

24.

Wang L, Zhao H, Zhu W, Yan P, Teng YD (2020) A combinatorial approach with cerebellar tonsil suspension to treating symptomatic Chiari malformation type i in adults: a retrospective study. World Neurosurg 143:e19–e35. https://doi.org/10.1016/j.wneu.2020.02.184CrossRefPubMed

Title: Outcome evaluation of decompression surgery combined with cerebellar tonsillectomy compared without cerebellar tonsillectomy for Chiari type I malformation patients
Authors: Jun Li
Taohui Ouyang
Ping Xu
Xiaofei Huang
Xie Song
Ping Wang
Wei Meng
Jiang Xu
Na Zhang
Publication date: 11-07-2022
Publisher: Springer Berlin Heidelberg
Keywords: Tonsillectomy
Syringomyelia
Published in: Neurosurgical Review / Issue 5/2022
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-022-01829-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcome evaluation of decompression surgery combined with cerebellar tonsillectomy compared without cerebellar tonsillectomy for Chiari type I malformation patients

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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