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. 2012;3(Suppl 3):S232-7.
doi: 10.4103/2152-7806.98580. Epub 2012 Jul 17.

Controversies in Chiari I malformations

Jamie Baisden  1
Affiliations

Controversies in Chiari I malformations

Jamie Baisden. Surg Neurol Int. 2012.

Abstract

Background: The diagnosis and management of Chiari I malformations (CMI) remains controversial, particularly since it is often an incidental finding on cervical MR scans performed for neck pain and/or headaches. Recently, some surgeons "over-operated" on asymptomatic patients with Chiari I malformations, or even on those without the requisite radiographic diagnostic features for Chiari I malformations: unfortunately, only a subset were admonished for indiscriminate surgery. Nevertheless, when this hindbrain malformation is truly symptomatic, contributing to impaired cerebrospinal fluid (CSF) circulation, various valid surgical management strategies may be adopted.

Methods: This review focuses on the current literature regarding the clinical presentation, diagnosis, and surgical management of Chiari I malformation. Variations in the surgical technique are also presented and critiqued.

Results: The recommended treatment for Chiari I malformations I consists of decompressive suboccipital craniectomy and duroplasty when abnormal cine-flow MRI is observed preoperatively and blockage of CSF flow persists intraoperatively despite bony decompression.

Conclusions: Controversy continues regarding the optimal surgical technique to address Chiari malformations I. Proper diagnostic studies and patient selection are needed to optimize patient outcomes, while avoiding unnecessary surgical procedures.

Keywords: Chiari malformation I; decompression; duroplasty; operative controversy; suboccipital craniectomy; surgical indications.

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References

    1. Battal B, Kocaoglu M, Bulakbasi N, Husmen G, Tuba Sanal H, Tayfun C. Cerebrospinal fluid flow imaging by using phase-contrast MR technique. Br J Radiol. 2011;84:758–65. - PMC - PubMed
    1. Caldarelli M, Di Rocco C. Diagnosis of Chiari I malformation and related syringomyelia radiological and neurophysiological studies. Childs Nerv Syst. 2004;20:332–5. - PubMed
    1. CryoLife (Life Restoring Technologies): BioGlue® Surgical Adhesive Syringe, Instructions for Use.
    1. Cui L-G, Jiang L, Zhang H-B, Liu B, Wang J-R, Jia J-W, Chen W. Monitoring of cerebrospinal fluid flow by intraoperative ultrasound in patients with Chiari I malformation. Clin Neurol Neurosurg. 2011;113:173–6. - PubMed
    1. Danish SF, Samdani A, Hanna A, Storm P, Sutton L. Experience with acellular human dura and bovine collagen matrix for duroplasty after posterior fossa decompression for Chiari malformations. J Neurosurg (1Suppl Pediatrics) 2006;104:16–20. - PubMed