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Arachnoid Opening With Dural Graft May Provide Optimal Treatment for Patients With Chiari I Malformation With Syringomyelia: Presented at AANS
By Mary Beth Nierengarten
CHICAGO -- May 5, 2008 -- For adults who are surgically treated for Chiari I malformation associated with syringomyelia, use of arachnoid opening with a dural graft may provide optimal resolution of symptoms and of syringomyelia, investigators reported from here at the 76th Annual Meeting of the American Association of Neurological Surgeons (AANS).
Rupa Gopalan, BS, Medical Student, School of Medicine, University of Virginia, Charlottesville, Virginia, and colleagues retrospectively evaluated outcomes of 58 adults who underwent posterior fossa decompression for Chiari I malformation with syringomyelia between 1995 and 2007.
Patients underwent suboccipital craniectomy alone or with cervical laminectomy; 40 patients had an arachnoid opening and 23 patients had a dural graft. Diagnosis of Chiari I malformation with syringomyelia was based on clinical symptoms (occipital headache, cervical pain, sensory loss, and paraesthesias) and magnetic resonance imaging findings showing tonsillar herniation and syrinx.
At a mean follow-up of 2.7 years, patients who underwent an arachnoid opening had a higher rate of complete syringomyelia resolution compared with patients in whom the arachnoid opening was left intact (P = .03). A higher rate of complete syrinx resolution and complete resolution of presenting symptoms were seen in patients who received a dural graft compared with those who did not (P = .02 and P = .006, respectively).
The study also found that the use of an arachnoid opening or a dural graft was not associated with major complications, contrary to what has been reported in other series, Dr. Gopalan said in her presentation on April 29.
"The major objection to arachnoid opening is risk of complications," she said. "What we found is that that is not necessarily the case and can be avoided."
Based on these results, she said that "the study suggests that Chiari I malformation is best treated by use of arachnoid opening."
[Presentation title: Outcome Analysis in Surgery for Adult Chiari I Malformation With Syringomyelia, With or Without Arachnoid Opening and Dural Graft. Abstract 704]
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