"Management: opinions from different centers"-the Sankt Augustin experience

Abstract

Objective: In this "how we do it" survey, we review our management regimen of symptomatic CM1 and provide an analysis of our institutional case series of "bony only" decompression of the craniocervical junction without dural opening.

Methods: In regard to the latter clinical symptomatology, neurological status, electrophysiology data, and pre- and post-surgical MRI were analyzed. Surgery was performed in standard fashion under IOM, evaluated by intraoperative ultrasound.

Results: We reviewed 22 patients (mean age at surgery 13 ± 7 years; 11 female, 11 male). Neck pain, occipital headaches, sensory symptoms, and dizziness were the predominating symptoms; 9% had central apnea, 5 patients had scoliosis, and 2 patients had a history of premature synostosis. On MRI, preoperative mean tonsillar herniation was 16.55 ± 6.19, compared to 14.25 ± 6.75 after surgery. About half of patients with syringomyelia (n = 11) experienced imagining improvement after surgery. Patients with neck pain, occipital headaches, dizziness, and sensory abnormalities benefited most from surgery. Of the 6 cases that presented with pathological SSEPs, 4 exhibited improved measurements after surgery. There were no postoperative complications.

Conclusion: To conclude bony decompression for CM1 resulted in clinical and imaging wise improvement and can be viewed as a safe first-lane option for symptomatic CM1.

Keywords: Bony-only; Chiari Malformation Type I; Clinical symptoms; Electrophysiology; MRI; Outcome.