Abstract:
BACKGROUND:The diagnosis of Chiari 1 malformation is based on the extent of tonsillar ectopia. OBJECTIVE:To examine the relationship between the extent of tonsillar ectopia and the intra-operative findings and clinical outcome following Chiari decompression surgery. METHODS:Patients were divided into four groups depending on the position of the cerebellar tonsil (T): group 1: 0 < T < 3; group 2: 3 ≤ T ≤ 5; group 3: 5 < T ≤ 10; and group 4: T > 10. Intra-operative observations were recorded with regard to compression of the brain stem by posterior inferior cerebellar artery (pica), neuroma formation along the first cervical (C1), and accessory spinal nerves (XI), and pallor of the cerebellar tonsils. Brain stem auditory evoked potentials, (BAEP), were monitored in each case. One hundred sixty-eight patients accrued between 2009 and 2013 agreed to participate in an outcome study to determine the effectiveness of foramen magnum decompression. Findings across the four groups were compared using one-way ANOVA. Observed differences were further subjected to paired analysis. Intra-group comparisons were made using the paired t test. A P value less than 0.05 was considered statistically significant. RESULTS:There were 98 patients in group 1, 147 patients in group 2, 180 patients in group 3, and 63 patients in group 4. The mean extent of tonsillar ectopia was 0.4, 4.0, 7.1, and 14.3 mm in the four groups respectively. The prevalence of tonsillar pallor was greatest in group 4. Otherwise, there was no difference observed in the operative findings. A reduction of > 0.1 msec in the wave III-wave V latency of the BAEP was noted in all four groups with equal frequency. One hundred ten patients complied with at least 6 months follow-up. There was no difference in the prevalence of symptoms between the four groups at the time of initial evaluation and at 6 weeks and 6 months following surgery. There was a statistically significant reduction in the intensity of individual symptoms 6 months following surgery regardless of the extent of tonsil ectopia. CONCLUSION:Other than the finding of tonsillar pallor, there was no relationship between the extent of tonsillar ectopia and the intraoperative anatomical and physiological observations, nor was there any relationship to the likelihood of symptomatic improvement following surgery. These observations call into question the focus on the extent of tonsillar of ectopia in assessing the patient who presents with symptoms of the Chiari malformation.
journal_name
Acta Neurochir (Wien)journal_title
Acta neurochirurgicaauthors
Heffez DS,Golchini R,Ghorai J,Cohen Bdoi
10.1007/s00701-019-04172-0subject
Has Abstractpub_date
2020-07-01 00:00:00pages
1539-1547issue
7eissn
0001-6268issn
0942-0940pii
10.1007/s00701-019-04172-0journal_volume
162pub_type
杂志文章abstract:OBJECTIVES:Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-r...
journal_title:Acta neurochirurgica
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更新日期:2015-11-01 00:00:00
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abstract::A 34-year-old female patient suffering from right-sided facial palsy presented to our hospital. Her hearing range was within normal limits. She had undergone GKS after receiving a diagnosis of facial nerve schwannoma (FNS). On the fourth day after GKS, the patient experienced sudden onset hearing loss on the right sid...
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更新日期:2014-02-01 00:00:00
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abstract::The clinical, radiological and surgical findings of 56 patients with congenital malformations of the craniovertebral junction who underwent surgical intervention in the Department of Neurosurgery, Hacettepe University Medical School were reviewed. The anomalies were classified according to their embryonic origin. Fort...
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更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:The generally accepted indications for carotid endarterectomy are the clinical picture and degree of per cent stenosis of the carotid artery. Despite the fact that stenosis measurement is defined, the methods vary considerably. The correlation of particular methods, especially angiography and duplex sonograp...
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abstract:OBJECT:Although functional mapping facilitates the planning of surgery in and around eloquent areas, the resection of tumors adjacent to language areas remains challenging. In this report, we took notice that the language areas (Broca's and Wernicke's) present at the perisylvian fissure. We posit that if there is non-e...
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abstract:BACKGROUND:Bariatric surgery (BS) is an increasingly common treatment for morbid obesity that has the potential to effect bone and mineral metabolism. The effect of prior BS on spine surgery outcomes has not been well established. The aim of this study was to assess differences in complication rates following spinal su...
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pub_type: 杂志文章
doi:10.1007/s00701-013-1931-6
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:To define the value of electrically elicited motor evoked potentials (MEP), obtained during the initial phase of the coma, for correct prediction of the post-coma motor status. METHODS:Fifty-two patients were investigated by MEP within 72 hours after onset of the coma. It was the aim to correlate the MEP fin...
journal_title:Acta neurochirurgica
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doi:10.1007/s007010050385
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abstract:BACKGROUND:Nonfunctioning pituitary macroadenoma (NFMA) is a benign neoplasm that causes visual function disturbances and headaches and can be treated by transsphenoidal surgery (TSS). It is unclear how quality of life (QOL) changes with surgery and which QOL factors are affected by treatment. METHODS:The aim is to as...
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journal_title:Acta neurochirurgica
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abstract:STUDY DESIGN:This report characterises a 25 year old male patient with a complete burst fracture of the fifth lumbar vertebra with dislocation. He was treated by posterior surgery with transpedicular instrumentation and an expandable cage from the posterior approach. OBJECTIVES:Burst fractures of the fifth lumbar vert...
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更新日期:2008-12-01 00:00:00
abstract::From a clinical standpoint recovery of spinal nerve roots is less likely than that of peripheral nerves, despite their identical structures. This may be due to several factors including the length of gap to be bridged, changes in the proximal stump or neuroma, and chromatolysis. In this paper we discuss the roles of s...
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pub_type: 杂志文章
doi:10.1007/BF01405874
更新日期:1976-01-01 00:00:00
abstract::Twiddler syndrome occurs when a patient intentionally or unintentionally manipulates an implantable generator (usually a pacemaker) and dislodges the pacing leads, causing malfunction of the device. Though the syndrome has been described in patients with pacemakers, to our knowledge only one spontaneous case has been ...
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doi:10.1007/s00701-009-0366-6
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:Cerebral cavernous malformations (CCM) are known to be highly epileptogenic lesions. A number of studies on CCM surgery deal with CCM-associated seizures and/or epilepsy. In order to counsel patients with CCM-associated epilepsy, clear results from such studies would be highly useful. This study reviews the ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
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更新日期:2011-02-01 00:00:00
abstract::The most frequent sequelae after severe brain injury include changes in personality traits, disturbances of emotional behaviour and impairment of cognitive functions. In particular, emotional changes and/or verbal and non verbal dysfunctions were found in patients with bilateral or unilateral temporal lobe lesions. Th...
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doi:10.1007/BF01405688
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:The effectiveness of repeated gamma knife radiosurgery (GKS) for the treatment of multiple metastatic brain tumours was evaluated. METHODS:This study included 16 patients with 242 tumours, 10 men and 6 women with a mean age of 60.3 years at initial GKS, who underwent GKS four times or more for newly develop...
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doi:10.1007/BF01407776
更新日期:1989-01-01 00:00:00
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更新日期:1993-01-01 00:00:00
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更新日期:2007-12-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/BF01476492
更新日期:1994-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2009-07-01 00:00:00
abstract::During follow-up of 485 adult patients with mainly mild head injury 27% of the patients were unemployed after an observation period of 3-5 years (mean 4.0 years). The length of sick leave during the last 3 years was longer than for a control group. Reduced physical capacity and time of sick leave during the last 3 yea...
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更新日期:1987-01-01 00:00:00
abstract::Treatment of vertebral epidural metastases has been in the past and still remains the object of special attention in an attempt to improve the quality of life of these patients. To assess the effects of and indications for surgery, the clinical histories of 53 patients with this malignant disease who had undergone dec...
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更新日期:1990-01-01 00:00:00
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更新日期:2016-10-01 00:00:00
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pub_type: 杂志文章
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更新日期:1975-01-01 00:00:00
abstract:BACKGROUND:Hyponatremia generally occurs after transsphenoidal surgery (TSS) in a delayed fashion. Most patients with delayed postoperative hyponatremia (DPH) are asymptomatic or only express non-specific symptoms; consequently, DPH is associated with prolonged hospitalization. No consensus has been reached on which pa...
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pub_type: 杂志文章
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更新日期:2019-04-01 00:00:00