Histological and intraoperative evaluations of the arachnoid in patients with Chiari I malformation
- PDF / 478,007 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 18 Downloads / 178 Views
ORIGINAL ARTICLE - NEUROSURGERY GENERAL
Histological and intraoperative evaluations of the arachnoid in patients with Chiari I malformation Moeid Heidary 1 & Michael Respondek 2 & Jörg Klekamp 3 Received: 3 June 2020 / Accepted: 15 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
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. Keywords Chiari I malformation . Syringomyelia . Arachnoid
Introduction The surgical treatment of Chiari I malformation has been discussed in recent years with great controversy. Recommendations range from foramen magnum decompression This article is part of the Topical Collection on Neurosurgery general * Jörg Klekamp [email protected] 1
Department of Ears, Nose and Throat (ENT), Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
2
Department of Pathology, St. Marien-Hospital, Marienstr. 6–8, 49377 Vechta, Germany
3
Department of Neurosurgery, Christliches Krankenhaus Quakenbrück, Danziger Str. 2, 49610 Quakenbrück, Germany
with arachnoid dissection, tonsillar shrinkage, and duraplasty [9] to minimal invasive subpial tonsillectomy without duraplasty [2], bony decompressions without dura opening [7, 20], decompressions w
Data Loading...
