The symposium is co-organised by The Ann Conroy Trust, in association with Aesculap Academia.
The Ann Conroy Trust is Registered Charity No: 1165808.
We provide Support, Education and Research for patients living with Chiari Malformation, Syringomyelia and associated conditions.
F12 Surgical revision of craniovertebral decompressions: a retrospective review.
Thanabalasundaram G, Silva A, Tsermoulas G, Flint G.
Craniovertebral decompression is performed for symptomatic Chiari type 1 malformation, with or without syringomyelia. The procedure usually improves Valsalva-related headaches and the syrinx often collapses but in a few patients the symptoms and/or the syrinx persist or recur, in which case revision surgery may be offered. The aim of this study was to examine the indications, technique and outcomes for revision craniovertebral decompression.
We retrospectively reviewed all revision craniovertebral decompressions performed in our centre over an eighteen-year period. We collected data on demographics, patient’s symptoms and imaging. We analysed the data with descriptive statistics. A total of 35 patients were identified (23 females, 12 males). Twenty patients had isolated Chiari 1 and 15 also had syringomyelia. The follow up period was 1-12 years (mean 3 years).
The mean time to revision was 80 months, range 9-264. For the majority (n=31) this was their 1st revision; for 3 it was their 2nd revision and in one case it was a 3rd revision. Overall, 32 of the 35 patients reported improvement after surgery, including all patients with syringomyelia. The symptom that improved most commonly was headache. Ten of the 15 syringomyelia patients demonstrated radiological resolution of the syrinx post-operatively and another 2 showed reduction in syrinx size. Out of the total group of 32 patients enjoying symptomatic improvement, 10 later developed symptom recurrence, with a mean time to recurrence of 12 months (range 5-24). Nine of these recurrences were in patients with only Chiari; the tenth recurrence was the only instance of such amongst the syringomyelia patients.
Revision craniovertebral decompression results in early symptomatic relief in most patients with Chiari 1 malformation and, in the medium-term, this benefit is sustained in about two thirds of patients.