Surgical decompression without dural opening for symptomatic Chiari type II malformation in young infants.

OBJECTIVE

Prompt surgical decompression for symptomatic Chiari type II malformation in neonates and young infants has been reported to be effective. However, the optimal operative method has been arguable. The authors present their experiences with surgical decompression without dural opening.

METHODS

We retrospectively analyzed surgical results of patients with symptomatic Chiari type II malformation. The charts were reviewed for demographic data, clinical presentation, surgical procedures, and clinical outcomes.

RESULTS

Ten consecutive patients with symptomatic Chiari type II malformation were surgically treated from August 2004 to December 2012. The mean age was 3.5 months. The median interval between onset of symptoms and surgery was 19.5 days. Three patients were treated by upper cervical bone decompression with dural opening and duraplasty. Seven patients were treated by upper cervical bone decompression with delamination of the outer layer of the dura. There were no perioperative complications. The mean follow-up period was 55 months (range 3-102 months). All 10 patients remain alive. In patients with dural opening, one patient showed complete recovery, and two patients had residual deficits and required a tracheostomy, one with ventilator support and the other with home oxygen therapy. In patients without dural opening, six patients (85 %) showed complete or nearly complete recovery, and one patient required tracheostomy and home oxygen therapy.

CONCLUSION

Upper cervical bone decompression with delamination of the outer layer of the dura can be a safe and effective treatment for symptomatic Chiari type II malformation in neonates and young infants.