Minimally Invasive Technique for Chiari I Decompression Without Durotomy: Surgical Technique and Preliminary Case Series

Matias Costa, Mauricio J. Avila, Juan Vivanco-Suarez, Patrick Karas, Stephen Monteith, Akshal Patel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Chiari I malformation, marked by severe headaches and potential brainstem/spinal cord issues, often requires surgical intervention when conservative methods fail. This study introduces a minimally invasive surgery (MIS) Chiari decompression technique utilizing a 3-blade retractor, aiming to reduce postoperative discomfort and optimize outcomes. Methods: Chiari type I malformation patients who underwent a MIS technique were included. Technique consisted of a minimal-soft tissue opening using a 3-blade retractor, suboccipital craniectomy, C1 laminectomy, and resection of the atlantooccipital band without a durotomy. Results: Ten patients were treated. Mean age was 43.3 years, with 7 female patients. All patients presented with occipital headaches; 50% retroorbital pain; 40% neck, upper back, or shoulder pain; and 30% limb paresthesias. Median pre-surgical modified Rankin Scale (mRS) was 3 (2–4) and pain visual analog score (VAS) was 7 (5–9). Mean operative time was 59 (59–71) minutes, with mean blood loss of 88.5 (50–140) mL. In our sample, 90% of patients were discharged the same surgical day (mean 7.2 [5.3–7.7] hours postoperative). No immediate or delayed postoperative complications were evidenced. At 6 months, 90% of patients had mRS 0–1. At last follow-up the mean VAS was 1.5 (range: 0–4, P < 0.001). Conclusions: The MIS 3-blade flexible retractor technique for Chiari decompression is feasible, provides wide visualization angles of the suboccipital region and C1 arch, allows 2-surgeon work, and minimizes skin and soft tissue disruption. This combination may diminish postoperative discomfort, reduce the risk of surgical site infections, and optimize outcomes.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - 2024

Keywords

  • Cerebrospinal fluid
  • Chiari I
  • Chiari malformation type 1
  • Minimally invasive
  • Neck pain
  • Suboccipital craniectomy
  • Tubular retractor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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