Posterior fossa decompression for Chiari malformation complications [Neurosurgery Wiki]

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====== Posterior fossa decompression for Chiari malformation complications ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1R5mb94PzUMkSOg91aCvG9QDHsmkemgW7wTCuqgwLZTqaqC1Ll/?limit=15&utm_campaign=pubmed-2&fc=20231115060826}}
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After [[suboccipital craniectomy]] plus C1–3 [[cervical laminectomy]] in 71 patients, with [[dural graft]] in 69, one death due to [[sleep apnea]] occurred 36 hrs post-op. Respiratory depression was the most common post-op complication (in 10 patients), usually within 5 days, mostly at night. Close respiratory monitoring is therefore recommended
((Paul KS, Lye RH, Strang FA, et al. Arnold-Chiari
Malformation: Review of 71 Cases. J Neurosurg.
1983; 58:183–187)).
Other risks of the procedure include: Cerebrospinal fluid fistula, herniation of cerebellar hemispheres, vascular injuries (to PICA…).
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Systematic [[review]] of observational [[studies]] reveals higher reoperation rates after bony [[decompression]] alone, but clinical [[improvement]] was not higher after primary decompression with [[duraplasty]]. There are so far no high-quality studies that offer guidance in the choice of decompressive technique in adult CM1 patients
((Förander P, Sjåvik K, Solheim O, Riphagen I, Gulati S, Salvesen O, Jakola AS. 
The case for duraplasty in adults undergoing posterior fossa decompression for
Chiari I malformation: A systematic review and meta-analysis of observational
studies. Clin Neurol Neurosurg. 2014 Jul 21;125C:58-64. doi:
10.1016/j.clineuro.2014.07.019. [Epub ahead of print] Review. PubMed PMID:
25087160.
)).

Posterior fossa decompression for Chiari type 1 deformity is carried out to improve passage of [[cerebrospinal fluid]] (CSF) in patients with symptomatic [[Chiari I  malformation]]s (CM1), but the extent and means of decompression remains controversial. [[Dural opening]] with subsequent [[duraplasty]] may contribute to clinical [[outcome]], but may also increase [[complication]] risk. 




===== Hydrocephalus =====

see [[Hydrocephalus after posterior fossa decompression for Chiari type 1 deformity]].

===== Suboccipital Pseudomeningocele =====

see [[Suboccipital pseudomeningocele after posterior fossa decompression for Chiari type 1 deformity]].
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A report describes the circumstances of a patient with a [[cauda equina syndrome]] due to the development of a lumbar [[spinal subdural hygroma]] with ventral displacement of the [[cauda equina]] shortly following [[posterior fossa decompression for Chiari type 1 deformity]] (CM-I). This unusual, but clinically significant, complication was successfully treated with percutaneous drainage of the extraarachnoid CSF collection. Although there are a few cases of intracranial [[subdural hygroma]] developing after surgery for CM-I, often attributed to a pinhole opening in the arachnoid, as far as the authors can determine, a [[spinal subdural hygroma]] associated with surgery for CM-I has not been recognized
((Darwish HA, Oldfield EH. Lumbar subdural cerebrospinal fluid collection with
acute cauda equina syndrome after posterior fossa decompression for Chiari
malformation Type I: case report. J Neurosurg Spine. 2016 Sep;25(3):328-31. doi: 
10.3171/2016.2.SPINE151480. Epub 2016 Apr 15. PubMed PMID: 27081710.
)).

===== Bulbar edema =====
[[Bulbar edema]]