Differentiated approach to surgical treatment of Chiari anomaly of type 1 and syringomyelia

Purpose: To analyze the results of treatment of patients with Chiari type 1 anomalyand syringomyelia and to determine the optimal treatment tactics for patients with thispathology. Materials and methods: During the period from January 2012 to December 2016,304 patients with syringomyelia and Chiari anomaly of type 1 were treated, 141 of themwere operated. The average age of the patients was 56±8 years. The average period of illness before seeking medical help is 75±82 months. 58 men and 83 women participated inthe study. Patients underwent a detailed neurological examination prior to surgery, after theoperation and every 6-12 months thereafter. The maximum follow-up period for operatedpatients was 3.8 years, the minimum - 6 months (median - 1.4 years). Results: 141 patients underwent suboccipital craniectomy, which included a large occipitalforamen, about 3 cm in diameter, and C1 laminectomy. During the revision of the arachnoid shellof the large occipital tank after opening of the TMO, Type 1 arachopathy according to Klekampwas detected in 44 patients (31.2%), type 2 arachnopathy in 19 (13.5%). These patients weredissected adhesions and recovered liquor on the posterior surface of the cerebellum and spinalcord. Twelve (8.5%) observations required shunting of the IV ventricle. In 78 (55.3%) patients inthe absence of arachnopathy (0 type according to Klekamp), a necrosis of the arachnoid was notrequired. Resection of the tonsils of the cerebellum was performed in only 6 (4.3%) patients, whenthey fell to the C2 level of the vertebra and below and significantly complicated the cerebrospinalfluid flow. 2 (1.4%) patients with concomitant hydrocephalus performed subcccital decompressionperformed ventriculo-atrial shunt. Two (1.4%) patients with concomitant basilar impression weresubjected to one-stage transnasal endoscopic resection of the C2-vertebra tooth, suboccipitalcraniectomy, resection of the C1 arch, occipitospondylodesis. Conclusion: The accumulated experience makes it possible to consider that during andafter the indications performed suboccipital craniectomy, resection of the C1 arch, followed by theplasticization of TMO, and the restoration of the liquorodynamics in the cranio-vertebral regionis an effective method of treating syringomyelia associated with the Chiari type 1 anomaly.