Tonsil coagulation [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Tonsil coagulation ======
Surgical approaches for [[Chiari malformation type I]] (CM-I) complicated with [[syringomyelia]] (SM) are controversial, so we assessed the efficacy and safety of two widely used procedures.

Methods: We retrospectively analyzed results from posterior fossa decompression (PFD) using bony decompression with dura-splitting or a combined technique (duraplasty with arachnoid dissection and coagulation of the herniated tonsils) for CM-I associated with SM between Jan 2008 and Feb 2016. Patients were followed up for at least one year. General data, primary outcomes (symptom improvement, syrinx reductions, and complications) and secondary outcomes (operating time, blood loss, postoperative hospital stay) for each procedure were compared.

Results: Of the 49 patients treated, 17 had dura-splitting decompression and 32 had the combined technique. There were no significant differences in general data. The combined technique was significantly superior to dura-splitting for long-term syrinx reductions (length, 100.03 ± 44.79 vs 72.73 ± 34.79 mm, p = 0.040; diameter, 8.09 ± 3.46 vs 5.73 ± 3.02 mm, p = 0.026) and symptom improvement (75.00% vs 47.06%, p = 0.036). No postoperative complications occurred during dura-splitting cases; however, complications occurred in 9 combined technique cases (31.25%, p = 0.010) and surgical time was longer for the combined technique (248.03 ± 60.12 vs 167.94 ± 60.11 min, p < 0.001).

Conclusions: The combined technique improved long-term symptoms and reduced syringes compared to dura-splitting; however, postoperative complications are more likely
((Abdallah A, Çınar İ, Güler Abdallah B. Long-term surgical outcome of Chiari
type-I malformation-related syringomyelia: an experience of tertiary referral
hospital. Neurol Res. 2022 Apr;44(4):299-310. doi:
10.1080/01616412.2021.1981104. Epub 2021 Sep 24. PMID: 34559033.)).
----


2: Roser F, Rigante L. Endoscopic-Assisted Resection of Anterior Foramen Magnum
Meningiomas through a Midline Suboccipital Subtonsillar Approach. J Neurol Surg
B Skull Base. 2021 May 17;83(Suppl 3):e641-e643. doi: 10.1055/s-0041-1727126.
PMID: 36068895; PMCID: PMC9440938.

3: Chotai S, Chan EW, Ladner TR, Hale AT, Gannon SR, Shannon CN, Bonfield CM,
Naftel RP, Wellons JC. Timing of syrinx reduction and stabilization after
posterior fossa decompression for pediatric Chiari malformation type I. J
Neurosurg Pediatr. 2020 Apr 24;26(2):193-199. doi: 10.3171/2020.2.PEDS19366.
PMID: 32330878.

4: Wang L, Zhao H, Zhu W, Yan P, Teng YD. A Combinatorial Approach with
Cerebellar Tonsil Suspension to Treating Symptomatic Chiari Malformation Type I
in Adults: A Retrospective Study. World Neurosurg. 2020 Nov;143:e19-e35. doi:
10.1016/j.wneu.2020.02.184. Epub 2020 Mar 12. PMID: 32173548.

5: Alexander H, Tsering D, Myseros JS, Magge SN, Oluigbo C, Sanchez CE, Keating
RF. Management of Chiari I malformations: a paradigm in evolution. Childs Nerv
Syst. 2019 Oct;35(10):1809-1826. doi: 10.1007/s00381-019-04265-2. Epub 2019 Jul
27. PMID: 31352576.

6: Valentini LG, Saletti V, Erbetta A, Chiapparini L, Furlanetto M. Chiari 1
malformation and untreated sagittal synostosis: a new subset of complex Chiari?
Childs Nerv Syst. 2019 Oct;35(10):1741-1753. doi: 10.1007/s00381-019-04283-0.
Epub 2019 Jul 21. PMID: 31327038.

7: Balestrino A, Consales A, Pavanello M, Rossi A, Lanteri P, Cama A, Piatelli
G. Management: opinions from different centers-the Istituto Giannina Gaslini
experience. Childs Nerv Syst. 2019 Oct;35(10):1905-1909. doi:
10.1007/s00381-019-04162-8. Epub 2019 May 9. PMID: 31073684.

8: Villa A, Imperato A, Maugeri R, Visocchi M, Iacopino DG, Francaviglia N.
Surgical Treatment in Symptomatic Chiari Malformation Type I: A Series of 25
Adult Patients Treated with Cerebellar Tonsil Shrinkage. Acta Neurochir Suppl.
2019;125:125-131. doi: 10.1007/978-3-319-62515-7_18. PMID: 30610312.

9: Choque-Velasquez J, Hernesniemi J. Unedited microneurosurgery of a fourth
ventricular ependymoma. Surg Neurol Int. 2018 Sep 10;9:186. doi:
10.4103/sni.sni_262_18. PMID: 30283719; PMCID: PMC6157041.

10: Marques de Almeida Holanda M, Costa do Nascimento JJ, Batista LL, Pinto
Kitamura MA, Cavalcanti Neto BF, Valença MM. Cerebellar Tonsillar Cysts
Associated with Chiari Malformation in Adults: A Short Series. World Neurosurg.
2018 Dec;120:205-210. doi: 10.1016/j.wneu.2018.08.165. Epub 2018 Aug 31. PMID:
30176398.

11: Geng LY, Liu X, Zhang YS, He SX, Huang QJ, Liu Y, Hu XH, Zou YJ, Liu HY.
Dura-splitting versus a combined technique for Chiari malformation type I
complicated with syringomyelia. Br J Neurosurg. 2018 Aug 27:1-5. doi:
10.1080/02688697.2018.1498448. Epub ahead of print. PMID: 30146911.

12: Bond AE, Jane JA Sr, Liu KC, Oldfield EH. Changes in cerebrospinal fluid
flow assessed using intraoperative MRI during posterior fossa decompression for
Chiari malformation. J Neurosurg. 2015 May;122(5):1068-75. doi:
10.3171/2015.1.JNS132712. Epub 2015 Feb 20. PMID: 25699415.

13: Galarza M, Gazzeri R, Alfieri A, Martínez-Lage JF. "Triple R" tonsillar
technique for the management of adult Chiari I malformation: surgical note. Acta
Neurochir (Wien). 2013 Jul;155(7):1195-201. doi: 10.1007/s00701-013-1749-2. Epub
2013 May 22. PMID: 23695377.

14: Witt CE, Wang AC, Maher CO, Than KD, Garton HJ, Muraszko KM. Patient with
Chiari malformation Type I presenting with inducible hemifacial weakness. J
Neurosurg Pediatr. 2011 Dec;8(6):620-4. doi: 10.3171/2011.9.PEDS11309. PMID:
22132921.

15: Kunert P, Janowski M, Zakrzewska A, Marchel A. Comparision of results
between two different techniques of cranio-cervical decompression in patients
with Chiari I malformation. Neurol Neurochir Pol. 2009 Jul-Aug;43(4):337-45.
PMID: 19742392.

16: Słoniewski P, Dzierzanowski J, Och W. Aneurysm of the meningeal branch of
the occipital artery connecting with the distal portion of the posteroinferior
cerebellar artery by the dural fistula. Folia Morphol (Warsz). 2008
Nov;67(4):292-5. PMID: 19085871.

17: Asgari S, Engelhorn T, Bschor M, Sandalcioglu IE, Stolke D. Surgical
prognosis in hindbrain related syringomyelia. Acta Neurol Scand. 2003
Jan;107(1):12-21. doi: 10.1034/j.1600-0404.2003.01357.x. PMID: 12542508.

18: Lazareff JA, Galarza M, Gravori T, Spinks TJ. Tonsillectomy without
craniectomy for the management of infantile Chiari I malformation. J Neurosurg.
2002 Nov;97(5):1018-22. doi: 10.3171/jns.2002.97.5.1018. PMID: 12450021.

19: Depreitere B, Van Calenbergh F, van Loon J, Goffin J, Plets C. Posterior
fossa decompression in syringomyelia associated with a Chiari malformation: a
retrospective analysis of 22 patients. Clin Neurol Neurosurg. 2000
Jun;102(2):91-6. doi: 10.1016/s0303-8467(00)00073-1. PMID: 10817895.

20: Park JK, Gleason PL, Madsen JR, Goumnerova LC, Scott RM. Presentation and
management of Chiari I malformation in children. Pediatr Neurosurg. 1997
Apr;26(4):190-6. doi: 10.1159/000121190. PMID: 9436829.