Results of the surgical treatment of syringomyelia associated with Chiari malformation: analysis of 60 cases

RESULTS OF THE SURGICAL TREATMENT OF SYRINGOMYELIA ASSOCIATED WITH CHIARI MALFORMATION: ANALYSIS OF 60 CASES (ABSTRCT)^*. THESIS. SÃO PAULO, 2001.

JOSÉ ARNALDO MOTTA DE ARRUDA^**

The author analyzes the results from surgical treatment in 60 patients suffering from syringomyelia associated with Chiari malformation, operated in the period of 1982-2000. Those patients are part of a universe of 129 patients suffering from malformation at the level of occipitocervical transition, that is, basilar impression and/or Chiari malformation, with the simultaneous occurrence of syringomyelia in 46.5% of cases.

Patients' ages ranged between 15 and 58 years, averaging 36.5 years. Patients included 32 females and 28 males. Most frequent initial symptoms included the difficulty to perform simple handworks, occurring in 51.6% of cases, and cervical pain, in 26.6% of cases. The time for the development of the condition averaged 6.2 years. In each case, 15 signs and 16 symptoms were analyzed under a protocol separating signs and symptoms of syringomyelia from signs and symptoms of Chiari malformation. A score system was established in parallel with the protocol, which made the evaluation of treatment results easier.

Surgical treatment was adopted as soon as the clinical aggravation of the patient's conditions was evident. All cases were submitted to craniovertebral decompression and C1 and C2 laminectomy, and cerebellar tonsillectomy with repair of dura mater. Nine patients underwent occipitocervical fixation, while three of them underwent trans-oral resection of the axis odontoid process. One patient underwent a second surgery of syringopleural derivation. Most frequent surgical complication was pseudomeningocele that occurred in 23.3% of cases. No death occurred among the patients of this study. To evaluate the results, statistical tests of proportion difference and variance analysis were applied with a reliability of 95% (p = 0.05).

It was concluded that signs and symptoms of Chiari malformation show very significant statistical improvement. Signs and symptoms of syringomyelia also improved significantly, among which the sign muscular atrophy improved best. An exception was the sign hyporeflexia of upper limbs, which did not improve. Among the signs and symptoms attributed to both syringomyelia and Chiari malformation, only hyperreflexia of upper limbs and sexual impotence did not improve. No statistical difference was found when comparing the improvement of syringomyelia symptoms to that of Chiari malformation. Syringomyelia signs statistically improved more than those of Chiari malformation. In half of patients, the percentage of improvement of signs and symptoms ranged between 40 and 60%.

KEY WORDS: syringomyelia, Chiari malformation, surgical treatment.

**Address: Avenida Beira Mar 3620 / 701, 60165-121 Fortaleza CE, Brasil.

*

Resultados do tratamento cirúrgico da siringomielia associada à malformação de Chiari: análise de 60 casos (Resumo). Tese de Doutorado, Escola Paulista de Medicina da Universidade de São Paulo (Área: Neurocirurgia). Orientador: Oswaldo Inácio de Tella Jr.

Publication Dates

• Publication in this collection
  11 Apr 2002
• Date of issue
  Mar 2002