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- Title
Clinical Spectrum and Surgical Management of Patients with Chiari-I Malformation.
- Authors
Khan, Zahid Ullah; Zeb, Aurang; Zeb, Ahmed; ur Rehman, Riaz; Jan, Rahman Ullah
- Abstract
Objective: Chiari malformations (CMs) is the protrusion of hind brain tissue into the cervical vertebral canal through the foramen magnum. They are divided into four types i.e. I, II, III, and IV with type Zero and type 1.5 as sub classification. Patients of Chiari malformation present with variety of clinical symptoms and signs. These malformations frequently occur with hydrocephalus, spinal dysraphasim and kyphoscoliosis. Among these, surgical treatment is reserved only for symptomatic patients with CIM. Further clinical research is needed for determining the most acceptable surgical intervention among several available techniques. It is hypothesized that PF decompression with atlas posterior arch removal and augmentation duroplasty is a better surgical procedure for symptomatic CIM patients. This is a prospectively conducted randomized control trials, which was conducted at the Department of Neurosurgery, Naseer Teaching Hospital Peshawar from March 2017 to March 2020. Material and Methods: Both genders and all age groups were included in the study. Data was collected from four tertiary care hospitals in Peshawar, Pakistan. All the patients (n=84) were distributed randomly into group A and B with clinical and radiological findings of CIM. In Group B(n=42), simple Posterior fossa decompression with atlas post arch removal was done while in Group A (n=42), augmentation duroplasty was also done in addition. For dataset analysis, SPSS version 22 software was used. Result: Among the 84 patients, 57 patients (67.9 %) were females and 27 (32.1 %) were males. Occipital headache (76 %,n=64) was main symptom followed by unilateral or bilateral arms pain and fingers numbness (15.5 %, n=13). In four patients (4.7 %), gait was main problem while three patients (3.6 %) had trigeminal neuralgia along with same side hand weakness. In group B, 11 patients (26.2 %) required repeat surgery for complete relief while in group B, all patients except two did well on routine follow ups. In Group A, CSF leak was main post-operative problem. Conclusions: symptomatic CIM patients, PF decompression with augmentation duroplasty is a superior option.
- Subjects
PESHAWAR (Pakistan); SPECTRUM allocation; RHOMBENCEPHALON; ARNOLD-Chiari deformity; SPINAL canal; OPERATIVE surgery; LAMINECTOMY; SPINAL canal diseases
- Publication
Ophthalmology Update, 2020, Vol 18, Issue 3, p45
- ISSN
1993-2863
- Publication type
Article