Surgical therapies in the management of Chiari I malformation

Objective To evaluate and compare the efficacy among posterior fossa decompression, posterior fossa decompression combined with duraplasty and posterior fossa decompression with cerebellar tonsil exploration in the treatment of Chiari Ⅰ malformation(CM Ⅰ). Methods We retrospectively studied 161 Chiari Ⅰ malformation patients treated between Janurary 1997 and September 2013. 52 patients received pure decompression of posterior cranial fossa, 64 patients underwent posterior fossa decompression with duraplasty , the rest with cerebellar tonsil exploration. Results No patients died in three groups after operation.The improvement rate of headache were 81.3%, 79.6% and 80.0%(P>0.05)respectively in three groups. The extremity sensory disturbance was improved in 33.3%, 65.4% and 65.0% patients respectively in three groups. The syringomyelia was decreased in 40.0%, 66.7% and 66.7% patients respectively in three groups. Conclusions Posterior fossa decompression was a reasonable option for the treatment of headache pain in Chiari Ⅰ malformation. Posterior fossa decompression with duraplasty and posterior fossa decompression with cerebellar tonsil exploration were good choice in the treatment of extremity sensory disturbance and syringomyelia. Key words: Chiari malformation; Syringomyelia; Decompression of posterior cranial fossa