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Review
. 2015 Oct;26(4):543-53.
doi: 10.1016/j.nec.2015.06.009. Epub 2015 Aug 4.

Surgical History of Sleep Apnea in Pediatric Patients with Chiari Type 1 Malformation

Isaac Jonathan Pomeraniec  1 , Alexander Ksendzovsky  1 , Pearl L Yu  1 , John A Jane Jr  2
Affiliations
Review

Surgical History of Sleep Apnea in Pediatric Patients with Chiari Type 1 Malformation

Isaac Jonathan Pomeraniec et al. Neurosurg Clin N Am. 2015 Oct.

Abstract

Sleep apnea represents a relative indication for posterior fossa decompression in pediatric patients with Chiari malformation type 1. Duraplasty was associated with improvement of sleep apnea in 100% of patients and dural splitting with improvement in 50% of patients. Duraplasty and dural splitting were associated with a similar reduction in tonsillar herniation on radiographic imaging of 58% (37% excluding tonsillectomy) and 35%, respectively. Longitudinal follow-up studies of patients with either neurologic deficits or severe symptoms will further elucidate the natural history of Chiari malformation type 1 and more appropriately gauge the risk-benefit tradeoff of surgical intervention.

Keywords: Chiari malformation; Dural splitting; Duraplasty; Sleep apnea.

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Figures

Figure 1
Figure 1. Suboccipital craniectomy
A–C: Bone removal of the foramen magnum. Foramen magnum decompression was performed measuring a minimum of 2 cm wide and 2 cm above the foramen
Figure 2
Figure 2. Duraplasty
A: removal of thick fibrous dural band. B–C: dural tack-up suture. D–E: open arachnoid, no adhesions. F–G: duraplasty. H–I: tonsillopexy
Figure 3
Figure 3. Dural splitting
For those who underwent dural splitting, the superficial layer of the dura was split and opened without completely cutting through the inferior layer until the dura was translucent. A: incising the dura. B: splitting the dural band at the foramen magnum. C–F: bluntly dissecting between the leaves of the dura and then sharply dividing perpendicularly to periosteal fibers. G–H: thinned dura. I: final thinned dura
See this image and copyright information in PMC

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