Research ArticleNew Technology

Accurate Posterior Fossa Decompression Technique for Chiari Malformation Type I and a Syringomyelia With Navigation: A Technical Note

Masato Tanaka, Sneha Sharma, Yoshihiro Fujiwara, Shinya Arataki, Toshinori Omori, Akihiro Kanamaru, Yuya Kodama, Hossam Saad and Taro Yamauchi
International Journal of Spine Surgery August 2023, 17 (4) 615-622; DOI: https://doi.org/10.14444/8483

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Preoperative radiograms of a 13-year-old girl with Chiari malformation type 1. (A and B) Severe scoliosis was shown, and its Cobb angles were 48° in the upper thoracic and 49° in main thoracic curve. (C) Bracing. (D and E) Cervical spine also had slight scoliosis.

  • Figure 2
    Figure 2

    Preoperative images of a 13-year-old girl with Chiari malformation type 1. (A) Sagittal reconstruction computed tomographic (CT) image; (B) 3-D CT image; (C) Mid-sagittal T2-weighted magnetic resonance image (MRI) showed the cerebral tonsile was downward into foramen magnum. (D) Axial T2-weighted MRI at C5 indicated a syrinx in the cervical cord.

  • Figure 3
    Figure 3

    Skin incision and reference frame (A). Approximately 7 cm skin incision was made from greater occipital protuberance to C2 spinous process (B).

  • Figure 4
    Figure 4

    Removal of C1 lamina. (A) Before removal. (B) Cut with a navigated high-speed burr. (C) Removal of C1 lamina.

  • Figure 5
    Figure 5

    Removal of a half of the C2 lamina. (A) Cut with a navigated high-speed burr. (B) Navigation monitor.

  • Figure 6
    Figure 6

    Posterior fossa decompression. (A) Intraoperative image. (B) Navigation monitor. (C) Intraoperative image.

  • Figure 7
    Figure 7

    Outer layer dural plasty and intraoperative ultrasonic monitoring. (A) Outer layer dural plasty. (B and C) Intraoperative ultrasonic monitoring. Red arrows show the subarachnoid space between the tonsile and dura.

  • Figure 8
    Figure 8

    Computed tomographic (CT) images of a 13-year-old girl with Chiari malformation type 1. (A) 45° 3-dimensional (3-D) CT image. (B) 60° 3-D CT image. (C) Axial image at C1. (D) Axial image at C2. (E) Mid-sagittal reconstruction CT image. The foramen magnum was efficiently decompressed (red arrows).

  • Figure 9
    Figure 9

    Follow-up images of a 13-year-old girl with Chiari malformation type 1. (A) Anteroposterior cervical radiogram. (B) Lateral cervical radiogram. (C) Mid-sagittal T2-weighted magnetic resonance image (MRI). (D) Axial T2-weighted MRI at C1. (E) Axial T2-weighted MRI at C5. MRI showed cerebral tonsile was released, and syringomyelia was reduced.

Tables

  • Table

    Summary of clinical results.

    No.Age, yGenderPreoperative SymptomsSurgical Time, minBlood Loss, mLComplicationsClinical Results
    111FScoliosis and headache10630NoExcellent
    211FNeck pain and hyperreflexia9860NoExcellent
    313FScoliosis, hyperreflexia, and muscle weakness12050NoGood
    415FScoliosis and headache116150NoGood
    520FScoliosis, hyperreflexia, and muscle weakness131120NoNo change
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Accurate Posterior Fossa Decompression Technique for Chiari Malformation Type I and a Syringomyelia With Navigation: A Technical Note
Masato Tanaka, Sneha Sharma, Yoshihiro Fujiwara, Shinya Arataki, Toshinori Omori, Akihiro Kanamaru, Yuya Kodama, Hossam Saad, Taro Yamauchi
International Journal of Spine Surgery Aug 2023, 17 (4) 615-622; DOI: 10.14444/8483
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