1. Posterior fossa decompression with duraplasty in chiari 1.
Dr. Iram Bokhari
Dr. Lal Rehman
Dr. Hamid Akbar
Prof A. Sattar M. Hashim
JPMC, Karachi.

2. Introduction
In 1891, Chiari (Professor of Pathology) was described a patient with herniation of the cerebellar tonsils below the foramen magnum.

3. Introduction…contd.

4. Introduction…contd.
Chiari 1 malformation is described as caudal displacement of cerebellar tonsils below the level of foramen magnum, more than 5 mm is generally considered

5. Aims & Objectives
- To find out the symptomatic outcome after decompressive duraplasty in chiari 1 malformation.

6. Material & Methods Design Descriptive case series
Duration July, 2008 – October, 2012
Patient Twenty one
Inclusion All patients of symptomatic chiari malformation with syrinx

7. Age

8. Male / Female

9. Clinical Features
Pts
Pain
Hand wk
Numbness
L/L 21 12 3

10. Operative Management Procedure No: of Pts 21 01 02 PFD with Duraplasty
syringosubarachnoid shunt 01
ventriculoperitoneal shunt 02
PFD=posterior fossa decompression

11. Prone Position for Surgery

15. Results Pre Op Post Op Pain Hand wk numb L/L Pain 21 -- Hand wk 12 03--
Hand wk 12 03
Numbness 21 02
L/L 01

16. Post Op Complications Complication PTS CSF LEAK 01 WOUND INFECTION
DETERIORATION
NIL VA O1
MORTALITY

17. Discussion
Chiari 1 malformation is caudal decent of cerebellar tonsil >5mm below the foramen magnum
Generally no descent of brain stem
Not associated with Mylomeningocele
Syrinx 50% - 75%
Hydrocephalus 1 – 10%
Platybasia, basilar invagination, Klippel-feil, scoliosis are also seen

18. Discussion…contd.
Hydrodynamic theory of Gardner stated that delayed opening of 4th ventricle outlets results in transmission of arterial pulse through a patent obex, producing a waterhammer effect that enlarges the central canal.
Williams theory of craniospinal pressure dissociation states that different pressures that exist between the cranial and spinal cavities causing syringomyelia.

19. Pain, head ache, numbness and weakness are major presenting symptoms
Pain, head ache, numbness and weakness are major presenting symptoms. These are also true in our series
JPMC
Gregg N et al
Pain
100%
81.5%
Weakness
57%
70%
Numbness
66%

20. Discussion..contd.
The surgical management of Chiari malformation has centered on bone decompression of foramen magnum.
Penfield and Cobern published 1st case of a posterior fossa decompression.
Gardner and Goodall proposed plugging the communication at obex with posterior fossa decompression.

21. Discussion…contd.
Logue and Edwards reported seven cases of laminectomy and syringosubarachnoid shunt after posterior fossa decompression had failed but obtain poor results.
Gregg N et al experience good results when posterior fossa decompression was combined with obex obliteration, 4th ventricle shunting and a dural graft.

22. Discussion…contd.
Our experience shows good results when posterior fossa decompression with duraplasty was done.

23. Conclusion Chiari 1 occurs in younger age Common in female Features
MRI
Surgical Options
PFD with Duraplasty has good results.

24. Thank You