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.
F9 Re-operation in Chiari patients: the role of the Chiari plate.
Ferreira F, Brodbelt A, Piggot T, Buxton N.
To investigate patient and surgical factors related to a successful outcome in patients undergoing revision Chiari surgery.
Retrospective case note audit, utilizing patient and clinician reported outcome scores, of patients who required revision Chiari surgery in a single institution from 2009. The role of C1 laminectomy, craniectomy size, duraplasty, arachnoid opening, cerebellar tonsillar cautery, shunting, and the use of the Chiari plate were examined. Outcomes were standardized and compared through Core Outcomes Measures Index (COMI) scores. Where COMI scores were absent, clinic letter outcome descriptions were used.
Seventeen patients were treated for recurrent symptoms. Nine patients had cerebellar slump and 8 of these underwent Chiari plate placement. COMI scores improved in 3 of these, remained stable in 1 and deteriorated in one. COMI score also deteriorated in one patient who was not plated. For three patients undergoing plate placement, only clinic outcome descriptions were available; 1 patient improved and 2 stabilized. Eight patients had undergone a previous, inadequate bony decompression. They underwent a larger craniectomy, with dural opening and tonsillar cauterization. Three of these were worse postoperatively and 4 needed shunting.
In revision Chiari surgery, the principles of maintenance of fluid dynamics, and conservative bony decompression are paramount. A Chiari plate can successfully help with treating cerebellar slump. Poor results appear to be mainly associated with the absence of duraplasty and shunt insertion.