Kompleks Chiari Olgularında Cerrahi Sorunlar ve Olası Başarısızlık Nedenleri

Abstract

Amaç: Chiari malformasyonları (CM), kraniovertebral bileşke ve arka beynin yaygın, oldukça değişken, konjenital problemleridir. Kompleks Chiari terimi, basit posterior fossa dekompresyonundan fayda görmeyen ve oksipitoservikal füzyon veya odontoidektomiye ihtiyaç duyan olguları tanımlamak için kullanılır. Dekompresyondan sonra kötüleşen bazı başarısız CM cerrahisi olgularını tartışmak için serimiz ve tıbbi literatür gözden geçirilmiştir. Gereç ve Yöntem: 2010-2020 yılları arasında CM tanısı alıp opere edilen hastalar incelenmiştir. Ayrıca Medline, PubMed ve Science veritabanları kullanılarak bibliyografya tabanlı bir araştırma yapılmıştır. Olası yanlış teşhis, klinik sorunlar ve cerrahi müdahalelerle ilgili tartışma için başarısız Chiari ameliyatı olan üç örnek olgu rastgele seçilerek sunulmuştur. Bulgular: CM tanısı konulan ve ameliyat edilen 60 hastanın ayrıntılı verileri incelenmiştir. Hasta serisi 37 kadın (%61,7) ve 23 erkekten (%38,3) oluşuyordu. Radyolojik incelemelerde hastaların %95’inde ortalama 11 mm (medyan 11 mm; 5-25; ±4.63) serebellar tonsil herniasyonu olduğu görüldü. 5 hastada (%8,33) Baziler İnvajinasyon, 1 hastada (%1,67) gergin omurilik malformasyonu, 1 hastada (%1,67) spina bifida ve 1 hastada (%1,67) spinal araknoid kist mevcuttu. Sonuç: CM’nin başarılı cerrahi tedavisi için ameliyat öncesi radyolojik değerlendirmenin yapılması ve bulguların klinik semptomlarla ilişkisinin belirlenmesi, cerrahi tedavinin kendisi kadar önemlidir.

Keywords

• Chiari Malformasyonları
• Kompleks Chiari
• Kraniyovertebral Bileşke
• Başarısız Chiari
• Oksipitoservikal Füzyon

Possible Reasons for Failure and Surgical Problems in Complex Chiari Cases

Abstract

Objectives: Chiari malformations (CM) are common, highly variable, congenital problems of the craniovertebral junction and hindbrain. The term complex Chiari is used o describe cases that do not benefit from simple posterior fossa decompression and require occipitocervical fusion or odontoidectomy. Our series and medical literature are reviewed to discuss some cases of failed CM surgery that worsened after decompression. Materials and Methods: Patients diagnosed with CM and operated between 2010 and 2020 were examined. In addition, a bibliography-based research was conducted using the Medline, PubMed and Science databases. Three sample cases of unsuccessful Chiari surgery are presented at random to discuss possible misdiagnosis, clinical problems, and surgical interventions. Results: Detailed data of 60 patients diagnosed with CM and operated on were analyzed. The patient series consisted of 37 women (61.7%) and 23 men (38.3%). On radiological examinations, 95% of the patients had a mean cerebellar tonsil herniation of 11 mm (median 11 mm; 5-25; ±4.63).Basilar Invagination was present in 5 patients (8.33%), tethered spinal cord malformation in 1 patient (1.67%), spina bifida in 1 patient (1.67%), and spinal arachnoid cyst in 1 patient (1.67%). Conclusion: For successful surgical treatment of CM, preoperative radiological evaluation and determining the relationship between findings and clinical symptoms are as important as surgical treatment itself.

Keywords

• Chiari Malformations
• Complex Chiari
• Craniovertebral Junction
• Failed Chiari
• Occipitocervical Fusion

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