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Year :2017
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Month :
January-February
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Volume :
6
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Issue :
1
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Page :
RO01 - RO05
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Role of MRI in Selection of Patients for Surgery and Assessing the Post Operative Outcome in Chiari 1 Malformation
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Correspondence Address :
Rajesh Kumar V, Vasu CK, Pavithran V, Navas KM, Fathima J,
Dr. Rajesh Kumar V
Department of Radiology, KMCT Medical College,
West Mambetta, Mukkom, Calicut-673602, Kerala, India.
E-mail: Kumar2476rd@gmail.com
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Introduction: Introduction: Chiari malformation also known as Arnold-Chairi malformation is a malformation of the skull. They are of four types among them Chiari 1 malformation is most common. It is characterised by inferior herniation of cerebellar tonsil through foramen magnum for more than 5mm and leads to compression of cervicomedullary junction and interruption of normal flow of CSF.
Aim: To identify patients with Arnold-Chiari malformation type 1 who are ideal candidates for early surgical intervention.
Materials and Methods: In this prospective study, 20 patients with age ranging from 15 to 47 years with Arnold-Chiari type 1 malformation were included. All the patients were evaluated with MRI brain and spine. Length of tonsillar herniation from foramen magnum, presence or absence of syrinx and maximum diameter of syrinx were assessed. Post operative outcome were evaluated by serial six months follow-up for resolution, reduction and persistence of symptoms.
Results: The mean age of patients with Chiari 1 malformation was 28 years. Chiari 1 malformation was common in females in our study. The mean duration of symptoms was 5.2 years. Ten patients had associated syrinx. Preoperative MRI showed the length of herniation between 6 to 10mm in seven patients and more than 10mm in 13 patients. In patients with syrinx mean maximum diameter of syrinx was 7.8 mm. Evaluation of postoperative patients for clinical recovery were done by serial follow-up at 1st, 3rd and 6th months. After surgery 9 patients with Chiari 1 malformation without syrinx had complete recovery. One patient without syrinx had partial recovery. Three patients with syrinx had complete recovery. Four patients with syrinx had partial recovery and three patients with syrinx had persistence of symptoms.
Conclusion: MRI has important role in diagnosing the Chiari 1 malformation and its association. Presence of syringomyelia and large diameter of syrinx implies a less favorable response to surgery. Patients without syrinx have better results with decompression. So, MRI plays a very important role in selection of patients for early surgical intervention and assessing the post operative outcome.
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