Surgical Treatment Of Chiari Malformation Associated With Syringomyelia

Objective: The surgical management of Chiari malformation associated with Syringomyelia is still controversial.Our study reviewed the differernt methods which treated the Chiari malformation associated with Syringomyelia,and through which we discuss the surgical treatment of Chiari malformation associated with Syringomyelia.Methods:We review 130 patients retrospectively,including their clinical and radiological findings,surgical treatment and the follow-up results,and analyse the results.There were 68 males and 62 females.We divided them into earlier surgery and latter surgery by using the year of 1998,the numbers of them are 61 and 63 respectively.A resection of the dens axis was performed in 6 patients.In the earlier surgery, posterior fossa decompression were performed in 14 patients,an additional syringosubarachnoid shunt were performed in 47 patients;in the latter surgery, posterior fossa decompression were performed in 58 patients, and an additional syringosubarachnoid shunt were performed in 5 patients, 17 patients which were included in the 58 patients received an additional syringocentesis.The methods of posterior fossa decompression were different in the two periods,for example,the area of bone decompression,the extent of removed cervical bone, resection of tonsils,duraplasty and so on.Collected the data of the effect of surgery when patients were discharged and the materials of the follow-up,then we analysised the data.Results:When the patients were discharged,the clinical signs and symptoms had been improved in 102 cases(78.46%),stabilized in 21 cases(16.15%),deteriorated in 5cases,and 2 patients were dead,one died from respiratory failure,anthoer died from infection. The mean follow-up for the cases were 2.86years(range from 3 months to 9 years),and the number was 103(79.23%). The clinical signs and symptoms had been improved in 9 cases,who received posterior fossa decompression in the earlier period,and the number was 30 in the cases received an additional syringosubarachnoid shunt in the same period. The number was 39 in those who received posterior fossa decompression in the latter period.Conclution:Chiari malformation is the fundamental cause of the patients of Chiari malformation associated with syringomyelia. When we treat this type of patients. we can use posterior fossa decompression , combined with resection of tonsil, exploration of median aperture of fourth ventricle and duraplasty.When we found that the deteriorated clinical signs and symptoms were caused by the remaining syringomyelia,the syringocentesis can be used for futher treatment.