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Vol. 22. Issue 1.
Pages 36-42 (January 2011)
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Vol. 22. Issue 1.
Pages 36-42 (January 2011)
Complicaciones postquirúrgicas de la malformación de Chiari tipo I: duroplastia y fístula de líquido cefalorraquídeo
Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak
J.M. Saceda-Gutiérrez
Corresponding author
Javisaceda@yahoo.es

Correspondencia: Servicio de Neurocirugía. 2ª Planta Hospital General. Paseo de la Castellana n° 261. 28046 Madrid.
, A. Isla-Guerrero, F. Álvarez-Ruíz, C. Odene-Cantero, B. Hernández-García, T.M. Márquez-Pérez
Servicio de Neurocirugía. Hospital Universitario La Paz. Madrid
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Abstract
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Resumen

El tratamiento quirúrgico de la malformación de Chiari tipo I consiste en realizar una descompresión ósea suboccipital. Está descrito que pueden producirse complicaciones derivadas de la cirugía, sobre todo si se realiza apertura dural y posterior cierre con injerto (duroplastia). Una de las más importantes por su difícil manejo, es la fístula de líquido cefalorraquídeo en la zona quirúrgica.

Objetivo

Llevar a cabo una revisión postquirúrgica, donde analizaremos la evolución de los pacientes y la correlación de las complicaciones respecto al tipo de plastia dural usada.

Material y métodos

Se ha realizado un estudio retrospectivo de los pacientes intervenidos en nuestro centro entre el año 1997 y 2008, ambos inclusive, recogiendo un total de 36 pacientes. A todos ellos se les realizó un estudio pre y postoperatorio con resonancia magnética craneoespinal, así como un examen neurológico antes y después de la intervención. La intervención quirúrgica consistió en una descompresión ósea suboccipital, junto con la extirpación del arco posterior de C1 o C2 (dependiendo del descenso amigdalar), y duroplastia con injerto autólogo (pericráneo) o con injerto heterólogo (Gore-tex).

Resultados

Tras un seguimiento medio de 2 años obtuvimos los siguientes resultados clínicos: excelente (55%), si hubo gran mejoría clínica; bueno (29%), si hubo leve mejoría; y malo (16%), si no hubo mejoría o hubo empeoramiento. En los 30 pacientes a los que se les realizó duroplastia (18 plastia artificial, 12 plastia autóloga de pericráneo occipital), aparecieron 6 casos de fuga de líquido cefalorraquídeo, no existiendo asociación significativa entre el tipo de plastia dural y la presencia de fístula.

Conclusiones

. Los síntomas que mejoran en mayor medida en los pacientes intervenidos en nuestro centro son la cefalea, el dolor cervical y el mareo. A pesar de existir mayor número de fístulas de líquido cefalorraquídeo en el grupo de pacientes con plastia artificial respecto al grupo con plastia de pericráneo, no es un hallazgo significativo.

Palabras clave:
Malformación de Chiari I
Duroplastia
Fístula de LCR
Pseudomeningocele
Siringomielia
Abreviaturas:
RM
LCR
Summary

The surgical treatment of Chiari I malformation is to carry out a suboccipital decompression. It is described that postoperative complications may occur, especially if the dura is open and closed using a graft (duraplasty). Among them, one of the most important events due to its difficult handling is cerebrospinal fluid leak through the suture line.

Objective

To conduct a postoperative review to analyze the outcome of the patients and the occurrence of complications depending on the dural plasty used.

Material and methods

A retrospective study was carried out between 1997 and 2008, both inclusive, where we assessed 36 patients. All of them were studied with preoperative and postoperative craneoespinal magnetic resonance, and by a thorough clinical examination performed before and after the surgery. The surgical procedure consisted of suboccipital decompression and resection of the posterior arch of C1 or C1 and C2 (depending on the extent of the caudal displacement of the tonsils), followed by duraplasty using either an autologous graft (pericranium) or a synthetic graft (Gore-tex).

Results

After a mean follow-up of 2 years, the clinical results were: excellent (55%), if there was a great clinical improvement; good (29%), if there was slight improvement; and bad (16%), if there was no improvement or there was worsening. In the 30 patients given a duraplasty (18 with an artificial graft, 12 with an autologous pericranium graft), 6 cases of cerebrospinal fluid leak appeared, although no significant association between the type of dural plasty and the presence of leak was observed.

Conclusions

The best results were obtained for headaches, cervical pain and dizziness. Despite the fact that there were more cases of cerebrospinal fluid leak in patients receiving an artificial graft compared to patients with pericranium graft, there was no significant difference.

Key word:
Chari I malformation
Duroplasty
CSF leak
Pseudomeningocele
Syringomyelia

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