Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases

The authors studied the role of the sole posterior fossa bony decompression in the management of symptomatic children affected by Chiari type I anomal ies. The series in the pediatric literature on this subject were reviewed a nd compared with that presented in this article. From May 1994 to December 1998, 53 patients (3 months to 26 years) were observed. They were divided i nto: asymptomatic patients (27), who received no surgical treatment and wer e only subject to clinical observation; symptomatic patients (brain stem co mpression 16, syringomyelia 10, including 7 with holocord). All the symptom atic patients were treated with the same surgical approach: bony decompress ion of posterior fossa with removal of the posterior arch of C-l and the ou ter layer of the dura without dural opening. In all 16 (100%) of the 16 pat ients with brain stem compression the symptoms resolved or improved; in pat ients with syringomyelia the symptoms were resolved or improved in 94.4% of cases. Two children required further surgery after 13 and 24 months, respe ctively. This series seems to demonstrate that even a simple extradural sur gical approach, with a lower rate of postoperative complications and short stay in hospital, is sufficient to arrest the disease and to improve the sy mptomatology in a high percentage of cases (97.2%), which is comparable to that achieved with other, more aggressive, procedures.