Concurrent Chiari decompression and spinal cord untethering in children: feasibility in a small case series

摘要

Background and purpose We describe the rationale and safety of concurrent decompression of Chiari type 1 malformation (CM1) and untethering of the spinal cord. Spinal cord traction is considered one of the pathogenic mechanisms involved in the development of CM, and 14% of patients with CM1 have tethered cord syndrome (Milhorat et al., Surg Neurol 7:20–35, 2009; Roth, Neuroradiology 21:133–138, 1981; Royo-Salvador, Rev Neurol 24:937–959, 1996; Royo-Salvador et al., Acta Neurochir 147:515–523, 2005). Therefore, intraspinal anomalies that require intervention are commonly treated before surgical decompression of Chiari malformation (Cheng et al., Neurologist 8:357–362, 2002; Menezes, Pediatr Neurosurg 23:260–269, 1995; Milhorat et al., Surg Neurol 7:20–35, 2009; Royo-Salvador et al., Acta Neurochir 147:515–523, 2005; Schijman and Steinbok, Childs Nerv Syst 20:341–348, 2004; Yamada et al., Neurol Res 26:719–721, 2004). However, in the interval between the spinal cord untethering and the decompression surgery, patients may continue to suffer from the untreated symptoms of CM. In a series of four patients with concurrent severe and progressive symptoms referable to both conditions, we performed both surgeries simultaneously.