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Histological and intraoperative evaluations of the arachnoid in patients with Chiari I malformation

  • Original Article - Neurosurgery general
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Abstract

Background

Arachnoid dissection for decompression of Chiari I malformation is controversial. Whether arachnoid changes have an impact on the clinical course is not established. This paper documents the histological spectrum of arachnoid changes and evaluates correlations with preoperative, intraoperative, and postoperative data.

Method

Arachnoid samples of 162 consecutive foramen magnum decompressions from 2006 to 2016 were studied. Arachnoid thickness and degrees of fibrosis and cellularity were determined with the examiner blinded for clinical data. Based on 145 first time decompressions, a histological classification for arachnoid features was developed.

Results

The arachnoid was thicker in secondary compared with primary decompressions (176.1 ± 158.2 μm vs. 35.9 ± 43.5 μm; p = 0.0026) and in adults compared to children (37.3 ± 45.3 μm vs. 21.8 ± 7.7 μm; p = 0.0007). In primary decompressions, arachnoid thickness, degrees of fibrosis, and cellularity followed a normal distribution with all features shifted significantly to higher grades in secondary decompressions. The histological classification correlated with the preoperative severity of gait ataxia, motor weakness, and sensory deficits, whereas it had no predictive power for postoperative short- or long-term results. By comparison, the intraoperative evaluation of arachnoid changes accounting for relationships between arachnoid and surrounding tissues showed higher correlations with preoperative symptoms and had significant predictive power for postoperative short- and long-term results.

Conclusions

Histological changes of the arachnoid correlate with preoperative symptoms. Relationships between arachnoid and surrounding tissues show even higher correlations with predictive power for short- and long-term outcomes. These findings suggest a pathophysiological role for the arachnoid in Chiari I malformation.

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Authors and Affiliations

  1. Department of Ears, Nose and Throat (ENT), Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany

    Moeid Heidary

  2. Department of Pathology, St. Marien-Hospital, Marienstr. 6–8, 49377, Vechta, Germany

    Michael Respondek

  3. Department of Neurosurgery, Christliches Krankenhaus Quakenbrück, Danziger Str. 2, 49610, Quakenbrück, Germany

    Jörg Klekamp

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  1. Moeid Heidary
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  2. Michael Respondek
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  3. Jörg Klekamp
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Correspondence to Jörg Klekamp.

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This study is in accordance with the ethical standards of the ethics committee of the Medical School of Hannover, Germany and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Heidary, M., Respondek, M. & Klekamp, J. Histological and intraoperative evaluations of the arachnoid in patients with Chiari I malformation. Acta Neurochir 163, 219–225 (2021). https://doi.org/10.1007/s00701-020-04582-5

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  • DOI: https://doi.org/10.1007/s00701-020-04582-5

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