Chiari 1 malformations: an Indian hospital experience

Ramnarayan R, Praharaj MS, Jayakumar PN
Correspondence: Dr Ramnarayan Ramachandran, r_ramnarayan@yahoo.com

ABSTRACT
Introduction A consensus on the ideal surgical procedure for Chiari 1 malformation has not been achieved. The purposes of the study were to report on the experience of treating this condition in an Indian hospital, and to look into the management of this not too uncommon condition with a view to improve the treatment and prognosis.
Methods A retrospective case note study of all cases of Chiari 1 malformations operated over a ten-year period from 1989 to 1999 and followed-up for another two years, were analysed for clinical and radiological features. All patients who underwent posterior fossa decompression were included. Patients who underwent other procedures like shunts were excluded. The data obtained included clinical and radiological features.
Results A total of 51 cases were analysed. All patients had posterior fossa decompression with duroplasty in the majority. Many patients had a delayed improvement noticed during the follow-up period. Headache, neck pain and motor features showed an improvement in the majority of the patients but sensory deficits did not.
Conclusion This study showed the effectiveness of posterior fossa decompression with duroplasty as a procedure, which benefited most patients with Chiari 1 malformations.

Keywords: cerebellar tonsils, Chiari 1 malformations, duroplasty, hindbrain herniation, posterior fossa decompression, syringomyelia
Singapore Med J 2008; 49(12): 1029-1034