Guinto-Balanzar G, Carlos Zamorano-Bórquez, Domínguez-Cortinas F, Aréchiga-Ramos NC, Abdo-Toro MA

Idioma: Español
Referencias bibliográficas: 40
Paginas: 115-122
Archivo PDF: 517.29 Kb.

RESUMEN

Antecedentes. El tratamiento de la malformación de Chiari de tipo I asociada a siringomielia es controvertido. En este trabajo se presenta un análisis clínico, quirúrgico y radiológico de los pacientes con esta afección que fueron manejados durante un periodo de doce años.
Material y métodos. Se incluyeron 48 pacientes, donde se encontró un discreto predominio en el sexo femenino. El cuadro clínico estuvo dominado por cefalea, dolor cervical, signos y síntomas cerebelosos, afección de nervios craneales bajos y lesión de la vía piramidal.
Resultados. Tanto el grado de descenso amigdalino como el tamaño de la siringomielia fueron muy variables, sin encontrar correlación entre ambos. La cirugía consistió en una craniectomía occipital, laminectomía de C1, ascenso de amígdalas cerebelosas mediante coagulación bipolar y plastía de duramadre. Los mejores resultados clínicos se obtuvieron en el dolor y los síntomas cerebelosos, mientras que los peores fueron en la afección de los nervios craneales bajos y de la vía piramidal, sin embargo, en la gran mayoría de los pacientes se logró detener la progresión de los síntomas. No se presentaron complicaciones serias en el presente estudio.
Conclusión. El procedimiento propuesto ofrece una alternativa segura, efectiva y comparable con otros métodos más riesgosos para el manejo de esta malformación.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Hadley DM. The Chiari malformations. J Neurol Neurosurg Psychiatry 2002;72:38-40.

2. Dones J, De Jesús O, Colen CB, Toledo MM, Delgado M. Clinical outcomes in patients with Chiari I malformation: a review of 27 cases. Surg Neurol 2003;60:142-148.

3. Alzate JC, Kothbauer KF, Jallo GI, Epstein FJ. Treatment of Chiari type I malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus 2001;11:1-9.

4. Blagodatsky MD, Larionov SN, Alexandrov YA, Velm AI. Surgical treatment of Chiari I Malformations with or without syringomyelia. Acta Neurochir (Wien) 1999;41:963-968.

5. Bradie B, Mendoza D, Batzdorf U. Posterior fossa volume and response to suboccipital decompression in patients with Chiari I malformation. Neurosurgery 1995;37:214-218.

6. Dyste GN, Menezes AH, VanGilder JC. Symptomatic Chiari malformations. An analysis of presentation, management, and long term outcome. J Neurosurg 1989;71:159-168.

7. Sindou M, Chavez-Machuca J, Hashish H. Cranio-Cervical decompression for Chiari Type I-Malformation, adding extreme lateral foramen magnum opening and expansile duroplasty with arachnoid preservation. Technique and long-term functional results in 44 consecutive adult cases – comparison with literature data. Acta Neurochir (Wien) 2002;144:1005-1019.

8. Bejjani G. Definition of adult Chiari malformation: a brief historical overview. Neurosurg Focus 2001;11:1-8.

9. Guinto G, Zamorano C, Domínguez F, Sandoval B, Villasana O, Ortiz A. Chiari I malformation: part I. Contemporary Neurosurgery 2004;26:1-8.

10. Alden TD, Ojemann JG, Park TS. Surgical treatment of Chiari I malformation: indications and approaches. Neurosurg Focus 2001;11:1-5.

11. Aboulezz AO, Sartor K, Geyer CA, Gado MH. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr 1985;9:1033-1036.

12. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. Am J Neuroradiol 1986;7:795-799.

13. Mikulis DJ, Diaz O, Egglin TK, Sanchez R. Variance of the position of the cerebellar tonsils with age: preliminary report. Radiology 1992;183:725-728.

14. Meadows J, Kraut M, Guarnieri M, Haroun RI, Carson BS. Asymptomatic Chiari type I malformations identified on magnetic resonance imaging. J Neurosurg 2000;92:920-926.

15. Iskandar BJ, Hedlund GL, Grabb PA, Oakes WJ. The resolution of syringohydromyelia without hindbrain herniation after posterior fossa decompression. J Neurosurg 1998;89:212-216.

16. Stovner LJ, Rinck P. Syringomyelia in Chiari malformation:relation to extent of cerebellar tissue herniation. Neurosurgery 1992;31:913-917.

17. Milhorat T, Chou M, Trinidad E, Kula R, Mandell M, Wolpert C, et al. Chiari I Malformation redefined:clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 1999;44:1005-1017.

18. Gardner WJ, Angel J. The mechanism of syringomyelia and its surgical correction. Clin Neurosurg 1958;6:131-140.

19. Williams B. Pathogenesis of syringomyelia. Acta Neurochir (Wien) 1993;123:159-165.

20. Oldfield EH, Muraszko K, Shawker TH, Patronas NJ. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 1994;80:3-15.

21. Bindal AK, Dunsker SB, Tew JM. Chiari I malformation:Classification and management. Neurosurgery 1995;37:1069-1074.

22. Logue V, Edwards MR. Syringomyelia and its surgical treatment—an analysis of 75 patients. J Neurol Neurosurg Psychiatry 1981;44:273-284.

23. Elster AD, Chen MYM. Chiari I malformations: clinical and radiological reappraisal. Radiology 1992;183:347-353.

24. Nishizawa S, Yokoyama T, Yokota N, Tokuyama T, Ohta S. Incidentally identified syringomyelia associated with Chiari I Malformations: Is early interventional surgery necessary? Neurosurgery 2001;49:637-641.

25. Sun JCL, Steinbok P, Cochrane DD. Spontaneous resolution and recurrence of a Chiari I malformation and associated syringomyelia. Case report. J Neurosurg (Spine 2) 2000;92:207-210.

26. Klekamp J, Iaconetta G, Samii M. Spontaneous resolution of Chiari I malformation and syringomyelia: case report and review of the literature. Neurosurgery 2001;48:664-667.

27. Munshi I, Frim D, Stine-Reyes R, Weir BKA, Hekmatpanah J, Brown F. Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated Hydromyelia. Neurosurgery 2000;46:1384-1390.

28. Nakamura N, Iwasaki Y, Hida K, Abe H, Fujioka Y, Nagashima K. Dural band pathology in syringomyelia with Chiari type I malformation. Neuropathology 2000;20:38-43.

29. Gambardella G, Caruso G, Caffo M, Germano A, La Rosa G, Tomasello F. Transverse microincisions of the outer layer of the dura mater combined with foramen magnum decompression as treatment for syringomyelia with Chiari I Malformation. Acta Neurochir (Wien) 1998;140:134-139.

30. Isu T, Sasaki H, Takamura H, Kobayashi N. Foramen magnum decompression with removal of the outer layer of the dura as treatment for syryngomyelia occurring with Chiari I malformation. Neurosurgery 1993;33:845-850.

31. Boop FA, Chadduck WM. Silastic duraplasty in pediatrics patients. Neurosurgery 1991;29:785-788.

32. Blagodatsky MD, Larionov SN. Surgical treatment of “hindbrain related” syringomyelia: long term results. Acta Neurochir (Wien) 1993;123:209-210.

33. Klekamp J, Batzdorf U, Samii M, Bothe HW. The surgical treatment of Chiari malformation. Acta Neurochir (Wien) 1996;138:788-801.

34. Guyotat J, Bret P, Jouanneau E, Ricci AC, Lapras C. Syringomyelia associated with type I Chiari Malformation. A 21-year retrospective study on 75 cases treated by foramen magnum decompression with a special emphasis on the value of tonsils resection. Acta Neurochir (Wien) 1998;140:745-754.

35. Hida K, Iwasaki Y, Koyanagi I, Sawamura Y, Abe H. Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery 1995;37:673-679.

36. Isu T, Iwasaki Y, Akino M, Abe H. Syringosubarachnoid shunt for syringomyelia associated with Chiari malformation (type I). Acta Neurochir (Wien) 1990;107:152-160.

37. Fujii K, Natori Y, Nakagahi H, Fukui M. Management of syringomyelia associated with Chiari malformation: comparative study of syrinx size and symptoms by magnetic resonance imaging. Surg Neurol 1991;36:281-285.

38. Widemayer H, Godde G. Problems in operative treatment of syringomyelia. Acta Neurochir (Wien) 1993;123:207-209.

39. Sgouros S, Williams B. A critical appraisal of drainage in syringomyelia. J Neurosurg 1985;82:1-10.

40. Iwasaki Y, Hida K, Koyanagi I, Abe H. Reevaluation of syringosubarachnoid shunt for syringomyelia with Chiari Malformation. Neurosurgery 2000;46:407-413.