Surgical management of Chiari malformation and syringomyelia: Experience in 14 cases.

Our experience with 14 patients afflicted with symptomatic Chiari malformation and syringomyelia, who were treated at King Khalid University Hospital between 1983 and 1990, is analyzed with reference to presentation, management, operative findings, and outcome. Patients with associated myelomeningocele, tethered cord, and spinal cord tumors were excluded from this series. The wide variations in natural history and clinical findings are emphasized. Neuroradiological studies included plain roentgenograms, myelograms, metrizamide-enhanced computed tomograms, and more recently magnetic resonance imaging scans. Posterior fossa decompression was the standard operation; other surgical procedures included syringosubarachnoid shunt, ventriculoperitoneal shunt, transoral odontoid resection, and terminal ventriculostomy. Four patients experienced definite improvement following surgery; the condition in seven was unchanged, and three suffered worsening of the disorder despite operation.