PT  - JOURNAL ARTICLE
AU  - Masato Tanaka
AU  - Sneha Sharma
AU  - Yoshihiro Fujiwara
AU  - Shinya Arataki
AU  - Toshinori Omori
AU  - Akihiro Kanamaru
AU  - Yuya Kodama
AU  - Hossam Saad
AU  - Taro Yamauchi
TI  - Accurate Posterior Fossa Decompression Technique for Chiari Malformation Type I and a Syringomyelia With Navigation: A Technical Note
AID  - 10.14444/8483
DP  - 2023 Aug 01
TA  - International Journal of Spine Surgery
PG  - 615--622
VI  - 17
IP  - 4
4099  - http://ijssurgery.com//content/17/4/615.short
4100  - http://ijssurgery.com//content/17/4/615.full
SO  - Int J Spine Surg2023 Aug 01; 17
AB  - Background Posterior fossa decompression (PFD) has been widely accepted for the surgical treatment for Chiari malformation type I (CM1). However, inadequate decompression causes surgical mortality and complications such as cerebrospinal fluid leakage, meningitis, or progression of syrinx and symptoms. The authors report a novel technique of PFD under navigation.Methods Five female patients with CM1 who developed severe symptoms and underwent surgical treatment were evaluated (mean age 14.0 years; mean follow-up 1.3 years). Surgical outcomes, surgical time, intraoperative blood loss, and operative complications were assessed.Results Four patients with CM1 who developed severe symptoms and underwent surgery were evaluated (mean age 14 years; mean follow-up 1.2 years). All patients were treated with PFD, C1 (and partial C2) laminoplasty to decompress the spinal cord under navigation guidance. Suboccipital craniectomy with 3 cm in diameter around the foramen magnum was performed. The postoperative radiograms and computed tomographic images showed adequate bony resection for CM1. Average surgical time was 114 minutes and average blood loss was 82 mL. There were no postoperative complications. After surgery, the numbness and muscle weakness of the patients were improved. The final follow-up magnetic resonance imaging displayed a good decompression of cerebral tonsile, and cervical syringomyelia was decreased.Conclusions PFD under navigation guidance can reduce inappropriate decompression and may decrease a revision surgery. During decompression surgery, cerebrospinal fluid leakage can be prevented using an ultrasonic bone cutter and navigation.Level of Evidence 5.