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Outcome evaluation of decompression surgery combined with cerebellar tonsillectomy compared without cerebellar tonsillectomy for Chiari type I malformation patients

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Abstract

Background

Surgical intervention is an important treatment option to improve the prognosis for Chiari type I malformation (CM-I) patients. However, there is no consensus about surgical strategies. The article intends to evaluate the effect of decompression combined with or without cerebellar tonsillectomy in the treatment of CM-I.

Method

Following PRISMA’s principles, Embase, PubMed, Web of Science, and Cochrane databases and references to relevant articles were searched to include only original articles on decompression combined with or without cerebellar tonsillectomy in CM-I patients. Through meta-analysis, the data on clinical improvement, radiological improvement, and complications were pooled.

Results

Nine articles, including 399 CM-I patients undergoing decompression alone and 343 undergoing decompression with cerebellar tonsillectomy, meet the inclusion standard. In comparison, the improvement rate of clinical symptoms or signs in patients with cerebellar tonsillectomy is higher and statistically significant (RR: 0.85, 95% CI: 0.75–0.95; P = 0.006). However, decompression with cerebellar tonsillectomy is also significantly higher in the incidence of postoperative complications (RR: 0.54, 95% CI: 0.36–0.80; P = 0.002). No statistical difference is discovered between the two groups in the improvement rate of syringomyelia (RR: 0.77, 95% CI: 0.57–1.03; P = 0.08).

Conclusions

Although decompression with cerebellar tonsillectomy is superior than decompression alone in clinical improvement for CM-I patients, it also faces a higher risk of postoperative complications. The reduction of syringomyelia in the two groups can be considered equally effective without significant differences. In the future, the results of the research require multicenter and large-scale randomized controlled trials to verify in clinical practice.

Trial registration: CRD42022321750 (PROSPERO).

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Data availability

The participant’s data were obtained from the published literature after searching databases; no available data exist.

References

  1. Antkowiak L, Tabakow P (2021) Comparative assessment of three posterior fossa decompression techniques and evaluation of the evidence supporting the efficacy of syrinx shunting and filum terminale sectioning in Chiari malformation type I. A systematic review and network meta-analysis. World Neurosurg 152:31–43. https://doi.org/10.1016/j.wneu.2021.05.124

    Article  PubMed  Google Scholar 

  2. Arnautovic A, Splavski B, Boop FA, Arnautovic KI (2015) Pediatric and adult Chiari malformation type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr 15:161–177. https://doi.org/10.3171/2014.10.peds14295

    Article  PubMed  Google Scholar 

  3. Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B (1998) Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg 88:237–242. https://doi.org/10.3171/jns.1998.88.2.0237

    Article  CAS  PubMed  Google Scholar 

  4. De Vlieger J, Dejaegher J, Van Calenbergh F (2019) Posterior fossa decompression for Chiari malformation type I: clinical and radiological presentation, outcome and complications in a retrospective series of 105 procedures. Acta Neurol Belg 119:245–252. https://doi.org/10.1007/s13760-019-01086-7

    Article  PubMed  Google Scholar 

  5. Delavari N, Wang AC, Bapuraj JR, Londy F, Muraszko KM, Garton HJL, Maher CO (2020) Intraoperative phase contrast MRI analysis of cerebrospinal fluid velocities during posterior fossa decompression for Chiari I malformation. J Magnetic Resonance Imaging : JMRI 51:1463–1470. https://doi.org/10.1002/jmri.26953

    Article  PubMed  Google Scholar 

  6. Durham SR, Fjeld-Olenec K (2008) Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr 2:42–49. https://doi.org/10.3171/ped/2008/2/7/042

    Article  PubMed  Google Scholar 

  7. Fan T, Zhao H, Zhao X, Liang C, Wang Y, Gai Q (2017) Surgical management of Chiari I malformation based on different cerebrospinal fluid flow patterns at the cranial-vertebral junction. Neurosurg Rev 40:663–670. https://doi.org/10.1007/s10143-017-0824-1

    Article  PubMed  Google Scholar 

  8. Fischer EG (1995) Posterior fossa decompression for Chiari I deformity, including resection of the cerebellar tonsils. Childs Nerv Syst 11:625–629. https://doi.org/10.1007/bf00300718

    Article  CAS  PubMed  Google Scholar 

  9. Flint G (2021) Syringomyelia: diagnosis and management. Pract Neurol 21:403–411. https://doi.org/10.1136/practneurol-2021-002994

    Article  PubMed  Google Scholar 

  10. Galarza M, Sood S, Ham S (2007) Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Childs Nerv Syst 23:691–696. https://doi.org/10.1007/s00381-007-0297-6

    Article  PubMed  Google Scholar 

  11. Geng LY, Liu X, Zhang YS, He SX, Huang QJ, Liu Y, Hu XH, Zou YJ, Liu HY (2018) Dura-splitting versus a combined technique for Chiari malformation type I complicated with syringomyelia. Br J Neurosurg 32:479–483. https://doi.org/10.1080/02688697.2018.1498448

  12. Guyotat J, Bret P, Jouanneau E, Ricci AC, Lapras C (1998) 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) 140:745–754. https://doi.org/10.1007/s007010050175

    Article  CAS  Google Scholar 

  13. Hoffman H, Bunch KM, Paul T, Krishnamurthy S (2021) Comparison of pericranial autograft and AlloDerm for duraplasty in patients with type I Chiari malformation: retrospective cohort analysis. Oper Neurosur (Hagerstown, Md) 21:386–392. https://doi.org/10.1093/ons/opab343

    Article  Google Scholar 

  14. Jia C, Li H, Wu J, Gao K, Zhao CB, Li M, Sun X, Yang B (2019) Comparison decompression by duraplasty or cerebellar tonsillectomy for Chiari malformation-I complicated with syringomyelia. Clin Neurol Neurosurg 176:1–7. https://doi.org/10.1016/j.clineuro.2018.11.008

    Article  PubMed  Google Scholar 

  15. Kahn EN, Muraszko KM, Maher CO (2015) Prevalence of Chiari I malformation and syringomyelia. Neurosurg Clin N Am 26:501–507. https://doi.org/10.1016/j.nec.2015.06.006

    Article  PubMed  Google Scholar 

  16. Koueik J, Sandoval-Garcia C, Kestle JRW, Rocque BG, Frim DM, Grant GA, Keating RF, Muh CR, Oakes WJ, Pollack IF, Selden NR, Tubbs RS, Tuite GF, Warf B, Rajamanickam V, Broman AT, Haughton V, Rebsamen S, George TM, Iskandar BJ (2019) Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study. J Neurosurg Pediatr 25:21–29. https://doi.org/10.3171/2019.8.peds19154

  17. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, Speer MC (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44:1005–1017. https://doi.org/10.1097/00006123-199905000-00042

    Article  CAS  PubMed  Google Scholar 

  18. Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y (1997) Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg 86:40–47. https://doi.org/10.3171/jns.1997.86.1.0040

    Article  CAS  PubMed  Google Scholar 

  19. Osborne-Grinter M, Arora M, Kaliaperumal C, Gallo P (2021) Posterior fossa decompression and duraplasty with and without arachnoid preservation for the treatment of adult Chiari malformation type 1: a systematic review and meta-analysis. World Neurosurg 151:e579–e598. https://doi.org/10.1016/j.wneu.2021.04.082

    Article  PubMed  Google Scholar 

  20. Phan K, Mobbs RJ (2015) Systematic reviews and meta-analyses in spine surgery, neurosurgery and orthopedics: guidelines for the surgeon scientist. J Spine Surg (Hong Kong) 1:19–27. https://doi.org/10.3978/j.issn.2414-469X.2015.06.01

    Article  Google Scholar 

  21. Pueyrredon F, Spaho N, Arroyave I, Vinters H, Lazareff J (2007) Histological findings in cerebellar tonsils of patients with Chiari type I malformation. Childs Nerv Syst 23:427–429. https://doi.org/10.1007/s00381-006-0252-y

    Article  PubMed  Google Scholar 

  22. Stanko KM, Lee YM, Rios J, Wu A, Sobrinho GW, Weingart JD, Jackson EM, Ahn ES, Chaichana KL, Jallo GI (2016) Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari type I malformation. J Neurosurg Pediatr 17:174–181. https://doi.org/10.3171/2015.6.peds14471

    Article  PubMed  Google Scholar 

  23. Wan MJ, Nomura H, Tator CH (2008) Conversion to symptomatic Chiari I malformation after minor head or neck trauma. Neurosurgery 63:748–753; discussion 753. https://doi.org/10.1227/01.neu.0000325498.04975.c0

  24. Wang L, Zhao H, Zhu W, Yan P, Teng YD (2020) A combinatorial approach with cerebellar tonsil suspension to treating symptomatic Chiari malformation type i in adults: a retrospective study. World Neurosurg 143:e19–e35. https://doi.org/10.1016/j.wneu.2020.02.184

    Article  PubMed  Google Scholar 

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Funding

The present study was supported by the National Natural Science Foundation of China (grant no. 81960247), Project of Science and Technology, Department of Jiangxi Province (grant no. 20202BABL206099).

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Author notes

  1. Jun Li and Taohui Ouyang contributed equally to this work.

    Na Zhang and Jiang Xu are co-corresponding authors of this article.

Authors and Affiliations

  1. Department of Neurology, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China

    Jun Li & Na Zhang

  2. Department of the Second Clinical Medical College of Nanchang University, Nanchang, Jiangxi Province, China

    Jun Li

  3. Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China

    Taohui Ouyang, Ping Xu, Xiaofei Huang, Xie Song, Ping Wang, Wei Meng & Jiang Xu

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  1. Jun Li
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Contributions

Jun Li: conceptualization, methodology, literature screening, and writing—original manuscript draft. Taohui Ouyang: funding acquisition, literature screening, and writing—reviewing and editing. Ping Xu and Xiaofei Huang: data collecting. Xie Song and Ping Wang: literature evaluation. Wei Meng: funding acquisition and software work. Jiang Xu and Na Zhang: statistical analysis and writing—reviewing and editing.

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Correspondence to Jiang Xu or Na Zhang.

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The participant’s data were obtained from the published literature after searching databases; no ethics approval is needed.

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Li, J., Ouyang, T., Xu, P. et al. Outcome evaluation of decompression surgery combined with cerebellar tonsillectomy compared without cerebellar tonsillectomy for Chiari type I malformation patients. Neurosurg Rev 45, 3315–3326 (2022). https://doi.org/10.1007/s10143-022-01829-w

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