Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Background: The surgical management of symptomatic adult Chiari malformation type 1 (CM1) with or without syringomyelia (SM) continues to be a dilemma considering the outcomes. Objectives: The study aimed to compare the clinical outcomes between stealth cranioplasty (SC) and one of the most commonly practiced standard procedures, posterior fossa decompression with duraplasty (PFDD). Clinical outcomes between SC and another procedure posterior fossa decompression (PFD) were also compared. Methods: This comparative cross-sectional study was carried out on 37 males and 16 females symptomatic adult CM1 patients, ranging from 18 to 47 years of age from June 2019 to May 2021. Clinical outcomes were assessed, compared, and analyzed in terms of changes in clinical symptoms and signs, chicago chiari outcome scale (CCOS) score, and occurrence of complications.  Results: Of the 53 patients, 23, 19 and 11 underwent SC, PFDD, and PFD, respectively. There were no significant post-operative changes in symptoms and signs among groups except changes in limb weakness between SC and PFDD (P=0.004). Considering average CCOS score, SC performed better only than PFDD (P=0.003), while category-wise SC was better than both PFDD (P=0.004) and PFD (P=0.010). Considering complications, the PFDD group had a significantly higher rate of complications than the SC group (P=0.001), while there was no significant difference in the rate of complications between the PFD and SC groups. Conclusion: SC was found to have better clinical outcomes than the PFDD and PFD groups as a technique. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 08-1

Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Background: The surgical management of symptomatic adult Chiari malformation type 1 (CM1) with or without syringomyelia (SM) continues to be a dilemma considering the outcomes. Objectives: The study aimed to compare the clinical outcomes between stealth cranioplasty (SC) and one of the most commonly practiced standard procedures, posterior fossa decompression with duraplasty (PFDD). Clinical outcomes between SC and another procedure posterior fossa decompression (PFD) were also compared. Methods: This comparative cross-sectional study was carried out on 37 males and 16 females symptomatic adult CM1 patients, ranging from 18 to 47 years of age from June 2019 to May 2021. Clinical outcomes were assessed, compared, and analyzed in terms of changes in clinical symptoms and signs, chicago chiari outcome scale (CCOS) score, and occurrence of complications.  Results: Of the 53 patients, 23, 19 and 11 underwent SC, PFDD, and PFD, respectively. There were no significant post-operative changes in symptoms and signs among groups except changes in limb weakness between SC and PFDD (P=0.004). Considering average CCOS score, SC performed better only than PFDD (P=0.003), while category-wise SC was better than both PFDD (P=0.004) and PFD (P=0.010). Considering complications, the PFDD group had a significantly higher rate of complications than the SC group (P=0.001), while there was no significant difference in the rate of complications between the PFD and SC groups. Conclusion: SC was found to have better clinical outcomes than the PFDD and PFD groups as a technique. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 08-1

Early outcome of radiculopathy with local application of steroid in perineural space in lumbar discectomy

Lumbar disc herniation resulting in compression and inflammation of nerve roots causes low back pain and radiculopathy. Per-operative use of steroids may help reduce inflammatory reaction and scar formation, causing less postoperative pain. The study aimed to assess the early outcome of radiculopathy with local application of steroids in peri-neural space after lumbar discectomy. This experimental study was carried out in the Department of Neurosurgery of the National Institute of Neuroscience and Hospital (NINS&H), Dhaka from March 2019 to August 2020. A total of 68 patients operated for prolapsed lumbar intervertebral disc (PLID) at L4/L5 and /or L5/S1 levels were divided into two groups. Patients who did not receive steroids (n=34) and those who received steroids (n=34) in peri-neural space were considered group A and group B, respectively. Patients were examined on the 1st, 2nd and 14th postoperative days to measure the pain intensity by the Visual Analogue Scale (VAS). Pre-operatively mean (standard deviation, sd) VAS was 7.41 (1.28) in Group A and 7.91 (0.9) in Group B (p-value >.05). Mean (sd) improvement of pain intensity on day 1, was 58.82 (17.55)% in Group A and 70.59 (12.26)% in Group B from pre-operative VAS. On day 2, 71.69 (12.43)% improvement was seen in Group A and 79.78 (9.74)% in Group B. On day 14, 75.37 (9.96)% improvement was seen in Group A and 83.46 (7.36)% in Group B from pre-operative. The improvements of VAS in all 1st, 2nd and 14th days were statistically significant (p-value <.05) between the two groups. Local application of steroids in peri-neural space found effective in reducing early postoperative radiculopathy following lumbar discectomy. BSMMU J 2022; 15(2): 107-10

“Stealth cranioplasty:” A novel endeavor for symptomatic adult Chiari I patients with syringomyelia: Technical note, appraisal, and philosophical considerations

Aim and Objective: In this article, we describe a novel technique of reconstruction of posterior fossa by cranioplasty with use of preshaped titanium mesh following posterior fossa decompression (PFD) for Chiari malformation type I (CMI) with syringomyelia (SM) in symptomatic adults. Materials and Methods: Eleven patients underwent limited PFD and expansive cranioplasty with preshaped titanium mesh, what we term as “Stealth Cranioplasty” (SCP), following arachnoid preserving duraplasty (APD) and hexagonal tenting of the duraplasty with the cranioplasty (HTDC) for the management of symptomatic adult CMI with SM. All these patients had syringes extending from 3 to >10 vertebral levels. Results: Seven male and four female symptomatic CMI adult patients, between age ranges of 22 and 44 years (mean 29.45 years), presented with different neurological symptoms related to CMI and SM for 6–84 months (mean 37.09 months). All the patients underwent PFD, APD followed by SCP and HTDC and were followed up for 7–54 months (mean 35.90 months). Of 11 patients, 8 patients improved according to the Chicago Chiari Outcome Scale (CCOS) with score of 13–15 while 3 patients remained unchanged with CCOS of 12, and there was no worsening. There was no complication related to Chiari surgery in any of the patients. All the patients had good reestablishment of cisterna magna. Two patients had marked reduction of syrinx while eight patients had moderate-to-mild reduction and one patient had no change of syrinx. None of the patients needed redo surgery. Conclusion: SCP is an effective, fruitful, and cost-effective technique for the management of symptomatic adult CMI with SM. This technique has the advantages of preventing complications and recurrences in addition to the improvement of symptoms by addressing the basic pathology