По всем вопросам звоните:

+7 495 274-22-22

УДК: 616-007.41 DOI:10.33920/med-01-2008-03

A clinical case of reoperation with Chiari malformation

Gilemkhanova Ilmira neurosurgeon physician Asp. of the Bashkir State Medical University; Children’s Republican Clinical Hospital; Ufa, Russian Federation; e-mail: ilmira2903@mail.ru, ORCID iD: 0000-0001-9476-6792
Safin Shamil M. prof., Doctor of Medicine; Bashkir State Medical University; Head of the Department of Neurosurgery of the Republican Clinical Hospital; Ufa, Russian Federation; e-mail: safinsh@mail.ru, ORCID iD: 0000-0002-0100-6100
Derevyanko Khristina PhD in Medical sciences; Bashkir State Medical University; Clinic of Bashkir Medical University; e-mail: khristina@mail.ru, ORCID iD: 0000-0002-4036-8649
Garifullina Nargiza Askatovna student of the Bashkir State Medical University; Ufa, Russian Federation; e-mail: Taga.maga@yandex.ru, ORCID iD: 0000-0001-9476-6792
For correspondence:
Gilemkhanova I. e-mail: ilmira2903@mail.ru
Safin S. M. e-mail: safinsh@mail.ru
Derevyanko K. e-mail: khristina@mail.ru
Garifullina N. A. e-mail: Taga.maga@yandex.ru
Ключевые слова: chiari malformation, syringomyelia, minimally invasive surgery, reoperation

Since the active introduction of neuroimaging methods, the prevalence of registered children with craniovertebral anomalies, including the Chiari malformation (CM), has a statistically significant tendency to increase. Minimally invasive surgical interventions are the most acceptable in pediatric neurosurgery, however, currently experience has been accumulated enough that does not confirm the universality of this method, due to the high frequency of reoperations at an older age, as well as a decrease of children’s quality of life in the interoperative periods. Considering the imperfection of treatment strategy mentioned above, the aim of this article was to analyze modern surgical interventions in pediatric and adult neurosurgeons with confirmation of our own results as an example of a clinical case of Chiari malformation in our clinic.


1. Avramenko T. V., Shevchenko A. A., Gordienko I. Yu. Arnold Chiari malformation. Prenatal clinical observations. Pediatrics Bulletin of VSMU. 2014; 13 (2): 87–95.

2. Kiryakov V. A. Clinic and diagnosis of craniovertebral anomalies. Zh. neurology and psychiatry. 1980; 80 (1): 1647–1652.

3. Kuzbekov A. R. Modern ideas about Chiari malformation / A. R. Kuzbekov, R. V. Magzhanov, Sh. M. Safi n. Neurology, BSMU. 2011: 118–125

4. Splavski B., Boop F. A., Arnautovic K. I. Pediatric and adult Chiari-1 malformation surgical series 1965–2013: a review of demographics, operative treatment, and outcomes.

5. Korshunov A. E. Rear decompression of the craniovertebral transition with Chiari-1 anomaly in children: the choice of the volume of operation / A. E. Korshunov, Yu. V. Kushel. The journal «Questions of Neurosurgery» named after N. N. Burdenko. 2016; 80 (4): 13–20.

6. Sansur C. A. Pathophysiology of headache associated with cough in patients with Chiari I malformation / C. A. Sansur, J. D. Heiss, H. L. DeVroom et al. J neurosurg. 2003; 98 (3): 453–458.

7. Edmeads J. The cervical spine and headache. Neurology. 1988; 38: 1874–1878.

8. Sanakoeva A. V. The results of posterior decompression of the craniovertebral transition in syringomyelia with Chiari-1 anomaly in children Asp., A. V. Sanakoeva Ph.D. A. E. Korshunov, Ph.D. Sh. U. Kadyrov, Ph.D. E. A. Khukhlaeva, MD Yu. V. Cough. Journal of Neurosurgery named after N. N. Burdenko. 2017; 3: 48–56.

9. Alzate J. C., Kothbauer K. F., Jallo G. I., Epstein F. J. Treatment of Chiari-1 malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurgical Focus. 2001; 11 (1): 1–9. DOI: 10.3171 / foc.2001.11.1.4.

10. Zhao J., Li M., Wang C., Meng W. A Systematic Review of Chiari I Malformation: Techniques and Outcomes. World Neurosurgery. 2016; 88: 714. DOI: 10.1016 / j.wneu.2015.11.0.087

11. Shin H.-S., Kim J. A., Kim D.-S., Lee J. S. Type I Chiari malformation presenting orthostatic syncope who treated with decompressive surgery. Korean J Pediatr. 2016; 59 (suppl 1): S149.

12. Arnautovic A., Splavski B., Boop F. A., Arnautovic K. I. Pediatric and adult Chiari-1 malformation surgical series 1965–2013: a review of demographics, operative treatment, and outcomes. Journal of Neurosurgery: Pediatrics. 2015; 15 (2): 161–177. DOI: 10.3171 / 2014.10.PEDS14295.

13. Galarza M., Sood S., Ham S. Relevance of surgical strategies for the management of pediatric Chiari-1 malformation. Child’s Nervous System. 2007; 23 (6): 691–696. DOI: 10.1007 / s00381-007-0297-6.

14. Stanko K. M., Lee Y. M., Rios J., Wu A., Sobrinho G. W., Weingart J. D., Chaichana K. L., Jallo G. I. Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari-1 malformation. Journal of Neurosurgery: Pediatrics. 2016; 17 (2): 174–181. DOI: 10.3171 / 2015.6.

Chiari malformation (CM) is a severe malformation of the craniovertebral region and a congenital pathology of the formation of the rhomboid brain, which manifests itself the as the form of a mismatch between the sizes of the posterior cranial fossa and the brain structures located in this region [1, 2].

In clinical practice, one of the main methods of treating the imbalance between the volume of neural formations and the capacity of the posterior cranial fossa is surgical intervention aimed to equalize the hydrodynamic pressure of the cerebrospinal fluid at the craniospinal junction, create a large occipital cistern and eliminate compression of the brain stem [3, 4].

In pediatric practice, in order to free the bulbo-medullary part of the brain and restore liquorodynamics, they perform minimally invasive decompression of the craniovertebral duraplasty transition and resection of the arch of the first vertebra. In adulthood, it is preferable to perform large-scale intra-arachnoid dissection, supplemented by coagulation and resection of the cerebellar tonsils (СT).

Minimally invasive interventions at children’s age is more advantageous because of a low risk of postoperative complications, but the higher frequency of long-term reoperations due to the ineffectiveness of the first intervention (13 % on average) [5], as well as the low percentage of regression of the manifestation of the main CM outcome, syringomyelia, is the price of safety .

Moreover, as a result of fragmentary elimination of the compressing factor during minimally invasive techniques, the incidence of headaches and suboccipital pains in the postoperative period during exercise is increased.

It is believed that headaches during active movements of the cervical spine are associated with sudden episodes of increased intracranial pressure [6]. According to J. Edmeads (1988), suboccipital headaches are caused by compression of C1-C2 roots by caudally displaced cerebellar tonsils [7].

Для Цитирования:
Gilemkhanova Ilmira, Safin Shamil M., Derevyanko Khristina, Garifullina Nargiza Askatovna, For correspondence:, Gilemkhanova I., Safin S. M., Derevyanko K., Garifullina N. A., A clinical case of reoperation with Chiari malformation. Вестник неврологии, психиатрии и нейрохирургии. 2020;8.
Полная версия статьи доступна подписчикам журнала
Язык статьи:
Действия с выбранными: