AI Chat Paper
Note: Please note that the following content is generated by AMiner AI. SciOpen does not take any responsibility related to this content.
{{lang === 'zh_CN' ? '文章概述' : 'Summary'}}
{{lang === 'en_US' ? '中' : 'Eng'}}
Chat more with AI
Powered by AMiner. Clicking this button will take you away from SciOpen.
Home Brain Science Advances Article
PDF (2.5 MB)
Cite
EndNote(RIS) BibTeX
Collect
Submit Manuscript AI Chat Paper
Show Outline
Outline
Show full outline
Hide outline
Outline
Show full outline
Hide outline
Research Article | Open Access

Clinical Efficacy of Minimally Invasive Subpial Tonsillectomy (MIST) for Treatment of Chiari Malformation (Type I) with Syringomyelia

Hao Li1( ), Zhiqiang Cui1, Yong Liu1
Neurosurgery Department, Yuquan Hospital of Tsinghua University, Beijing, 100040, China
Show Author Information

Abstract

Background

To investigate the clinical efficacy of minimally invasive subpial tonsillectomy (MIST) in the treatment of Chiari malformation (type I) with syringomyelia.

Methods

A total of 209 Chiari malformation (type I) patients with syringomyelia were studied. The patients were grouped based on the syrinx diameter changes: complete disappearance group (48 patients), obvious shrinkage group (147 patients), and non-obvious shrinkage group (14 patients). The Chicago Chiari Outcome Scale (CCOS) was used to compare clinical data of the three groups of patients before treatment. The correlations between disease duration and syrinx diameter changes as well as post-treatment clinical symptoms were analyzed. The related factors of efficacy were analyzed.

Results

Age and disease duration were the oldest/longest in the non-obvious shrinkage group, and the youngest/shortest in the complete disappearance group (P < 0.05). The maximum diameter reduction of syrinx was the greatest in the complete disappearance group, and the smallest in the non-obvious shrinkage group (P < 0.05). The proportions of patients with hypoesthesia, limb weakness, and muscle atrophy were the largest in the non-obvious shrinkage group, and the smallest in the complete disappearance group (P < 0.05). The CCOS score were the highest in the complete disappearance group, and the lowest in the non-obvious shrinkage group (P < 0.05). There were statistically significant (P < 0.05) negative correlations between disease duration and maximum diameter reduction of syrinx, CCOS pain score, CCOS non-pain score, CCOS functionality score, and CCOS complication score, disease duration and hypoesthesia, limb weakness, muscle atrophy, and sleep apnea. Result of multivariate stepwise regression analysis indicated that age, disease duration, and preoperative syrinx diameter were the risk factors for efficacy (P < 0.05).

Conclusion

For patients with Chiari malformation complicated by syringomyelia, the longer the disease duration, the more difficult it is to achieve syrinx reduction and improve the clinical symptoms. "Minimally invasive subpial tonsillectomy (MIST) and cisterna magna reconstruction" is an improved surgical approach to treat Chiari malformation (cerebellar tonsil herniation). It has the advantages of small incision, less postoperative reaction, and fewer complications, and it emphasizes the reshaping and repair of cerebellar tonsils, reconstruction of cisterna magna, and restoration of cerebrospinal fluid circulation.

Keywords

minimally invasive surgeryChiari malformation (type I)syringomyeliacisterna magna reconstructioncerebrospinal fluid circulation

References

[1]
Holly LT, Batzdorf U. Chiari malformation and syringomyelia. J Neurosurg Spine 2019, 31(5): 619–628.
Crossref Google Scholar
[2]
Galarza M, Sood S, Ham S. Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Childs Nerv Syst 2007, 23(6): 691–696.
Crossref Google Scholar
[3]
Lazareff JA, Galarza M, Gravori T, et al. Tonsillectomy without craniectomy for the management of infantile Chiari I malformation. J Neurosurg 2002, 97(5): 1018–1022.
Crossref Google Scholar
[4]
Soleman J, Bartoli A, Korn A, et al. Treatment failure of syringomyelia associated with Chiari I malformation following foramen magnum decompression: how should we proceed? Neurosurg Rev 2019, 42(3): 705–714.
Crossref Google Scholar
[5]
Guyotat J, Bret P, Jouanneau E, et al. Syringomyelia associated with type I Chiari malformation. A 21-year retrospective study on 75 cases treated by foramen magnum decompression with a special emphasis on the value of tonsils resection. Acta Neurochir 1998, 140(8): 745–754.
Crossref Google Scholar
[6]
Oró JJ, Mueller DM. Posterior fossa decompression and reconstruction in adolescents and adults with the Chiari I malformation. Neurol Res 2011, 33(3): 261–271.
Crossref Google Scholar
[7]
Duddy MJ, Williams B. Hindbrain migration after decompression for hindbrain hernia: a quantitative assessment using MRI. Br J Neurosurg 1991, 5(2): 141–152.
Crossref Google Scholar
[8]
Holly LT, Batzdorf U. Management of cerebellar ptosis following craniovertebral decompression for chiari I malformation. J Neurosurg 2001, 94(1): 21–26.
Crossref Google Scholar
[9]
Ellenbogen RG, Armonda RA, Shaw DW, et al. Toward a rational treatment of Chiari I malformation and syringomyelia. Neurosurg Focus 2000, 8(3): E6.
Crossref Google Scholar
[10]
Driver CJ, Volk HA, Rusbridge C, et al. An update on the pathogenesis of syringomyelia secondary to Chiari-like malformations in dogs. Vet J 2013, 198(3): 551–559.
Crossref Google Scholar
[11]
Tator CH, Meguro K, Rowed DW. Favorable results with syringosubarachnoid shunts for treatment of syringomyelia. J Neurosurg 1982, 56(4): 517–523.
Crossref Google Scholar
[12]
Hekman KE, Aliaga L, Straus D, et al. Positive and negative predictors for good outcome after decompressive surgery for Chiari malformation type 1 as scored on the Chicago Chiari Outcome Scale. Neurol Res 2012, 34(7): 694–700.
Crossref Google Scholar
[13]
Aliaga L, Hekman KE, Yassari R, et al. A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery 2012, 70(3): 656–664.
Crossref Google Scholar
[14]
di Lorenzo N, Cacciola F. Pathophysiology of syringomyelia. J Neurosurg 2000, 92(6): 1070–1071.
Crossref Google Scholar
[15]
Gardner WJ, Angel J. The mechanism of syringomyelia and its surgical correction. Clin Neurosurg 1958, 6: 131–140.
Crossref Google Scholar
[16]
Gardner WJ. Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry 1965, 28(3): 247–259.
Crossref Google Scholar
[17]
Williams B. The distending force in the production of “communicating syringomyelia”. Lancet 1969, 2(7613): 189–193.
Crossref Google Scholar
[18]
Williams B. Progress in syringomyelia. Neurol Res 1986, 8(3): 130–145.
Crossref Google Scholar
[19]
Heiss JD, Patronas N, DeVroom HL, et al. Elucidating the pathophysiology of syringomyelia. J Neurosurg 1999, 91(4): 553–562.
Crossref Google Scholar
[20]
Oldfield EH, Muraszko K, Shawker TH, et al. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 1994, 80(1): 3–15.
Crossref Google Scholar
[21]
Zhang YZ, Zhou DB, Qiao GY, et al. Reconstruction of the cistern Magna to treat the syringomyelia associated with Chiari type I malformation (in Chinese). Chin J Neurosurg 2000, 16(5): 274–276.
Google Scholar
[22]
Zhang YQ, Wang ZC, Ma ZY, et al. Chiari malformation with syringomyelia: surgical treatment with tonsillectomy plus central canal opening (in Chinese). Chin J Neurosurg 2004, 20(3): 215–217.
Google Scholar
Brain Science Advances
Volume 9 Issue 4,
December 2023
Pages 310-321
DOI: 10.26599/BSA.2023.9050021
Cite this article:
Li H, Cui Z, Liu Y. Clinical Efficacy of Minimally Invasive Subpial Tonsillectomy (MIST) for Treatment of Chiari Malformation (Type I) with Syringomyelia. Brain Science Advances, 2023, 9(4): 310-321. https://doi.org/10.26599/BSA.2023.9050021

456

Views

25

Downloads

0

Crossref

Altmetrics
Received: 31 May 2023
Revised: 15 September 2023
Accepted: 05 October 2023
Published: 05 December 2023
© The authors 2023.

This article is published with open access at journals.sagepub.com/home/BSA

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Return