View Full Version : Decompression surgery: human results

30th April 2008, 12:08 AM
Interesting article that may or may not have correlations in dogs of course -- but I think offers some possible insights (possibly not what one would expect).

Permanent link: http://conferences.medicexchange.com/en/news.aspx?articleid=410&zoneid=23

Research analyzes if decompression surgery provides pain relief to patients with two difficult to treat conditions: Chiari type 1 malformation and syringomyelia
Source: American Association of Neurological Surgeons
Author: Betsy van Die
Date: 29 April 2008

Chiari malformation is considered a congenital condition, although acquired forms of the condition have been diagnosed. A German pathologist, Professor Hans Chiari, first described abnormalities of the brain at the junction of the skull with the spine in the 1890s. He categorized these in order of severity; types I, II, III, and IV. These malformations are closely related to syringomyelia. Patients with syringomyelia and Chiari Type 1 often present with an intense, burning-type nerve pain and/or headaches, among other symptoms. The prevalence in the general population has been estimated at slightly less than one in 1000.

When cerebrospinal fluid (CSF) forms a cavity or cyst within the spinal cord, it is known as syringomyelia. This is a chronic disorder involving the spinal cord developing, expanding or extending over time. As the fluid cavity expands, it can displace or injure the nerve fibers inside the spinal cord. A wide variety of symptoms can occur, depending upon the size and location of the syrinx. Loss of sensation and pain are two of the symptoms. Syringomyelia can arise from several causes. While Chiari malformation is the leading cause, the direct link is not well understood.

Surgical treatment of Chiari depends on the type of malformation. The goal of surgery is to relieve or stop the progression of the syrinx and/or symptoms by decompressing nerve tissue and restoring normal CSF flow around and behind the cerebellum. Decompression provides more space for the brain stem, spinal cord, and descended cerebellar components. "This is a particularly challenging condition to diagnose and treat for several reasons. Many of the symptoms mimic other conditions such as fibromyalgia, and patients often go for years before receiving a proper diagnosis. While decompression surgery has proven to help some patients, there have been other cases in which the symptoms persisted, which warrants the need for in-depth outcome research," stated Kazutoshi Hida, MD, PhD, lead author of this study.

Researchers at the University of Hokkaido in Sapporo, Japan , analyzed the outcome of 66 patients with Chiari Type 1 or syringomyelia presenting with pain as one of their symptoms. The results of this study, Dysesthetic Pain in Patients with Syringomyelia and Chiari Type I Malformation, will be presented by Dr. Hida at 4:09 to 4:20 p.m. on Wednesday, April 30, 2008, during the 76th Annual Meeting of the American Association of Neurological Surgeons in Chicago. Co-authors are Yoshinobu Iwasaki, MD, PhD, and Shunsuke Yano, MD, PhD.

Since 1982, 148 patients with syringomyelia and Chiari Type I malformation have undergone surgery at the University of Hokkaido. Of these, 66 (17 men and 49 women) complained of pain preoperatively, and these patients were included in this study.

- Foramen magnum decompression (FMD) was performed on 36 patients and syringo-subarachnoid (S-S) shunting on 30 patients.
- Pain was more common in adult patients than in younger patients.
- Pain in one arm was the most frequently observed pattern in 79 per cent of patients.
- In 52 patients (78 per cent), preoperative magnetic resonance imaging (MRI) showed extension of the syrinx into the dorsolateral part of the spinal cord on the same side and level as the pain.

Postoperatively, MRI showed a reduction of the size of the syrinx in all 66 patients. Forty-six reported pain relief or improvement; 17 reported no change, and three experienced worsening of pain. In respect to pain outcome, there was no difference between patients treated with FMD and S-S shunting. "While surgery is effective in reducing the size of the syrinx, this reduction does not seem to correlate to pain relief. However, early syrinx reduction may minimize the long-term pain experienced by patients with syringomyelia."

"It is really key that patients with either of these conditions work closely with their neurosurgeons and other healthcare providers on pain management strategies, because while surgery may help, it does not always provide complete resolution of symptoms," concluded Dr. Hida.

14th July 2008, 10:08 PM
Who would have thought that when I rescued a CKC just over a year ago that I would find myself on this site reading about SM and chiari and not know that some 12 months later I myself would be diagnosed with exactly the same thing!
How bizarre. I took ill in Jan and since then following various tests and finally 2 MRI's I have been diagnosed with Chiari I malformation.

This condition varies very much by each individual and therefore for those people with dogs diagnosed I would like to say that surely it much vary by each dog and therefore try not to worry. I know everytime my CKC scratches her neck I wonder if she has SM...

15th July 2008, 12:41 AM
I am so sorry! I had no idea. :( I hope you are doing OK? Have you found some of the good human sites with information? The Conquer Chiari site in the US is particularly good. I know how useful I have found it and the ASAP site from the US. The Ann Conroy Trust site in the UK is really good too. I don't know about Irish resources but you have probably found those. Were you feeling ill for long time before the diagnosis?

15th July 2008, 09:42 AM
Fiddichs, I'm sorry to hear that you are battling wit this horrid condition too :flwr::flwr:

Living with several affected dogs, I know it's very unpleasant and can be difficult to manage.

I hope you are not struggling too much and keep reasonably well.

Karlin, thank you so much for sharing that - I was fascinated to read the surgery results, I guess not so dissimilar from what has been reported in the dogs.

15th July 2008, 09:45 AM
I'm sorry too and amazed you got a diagnosis so quickly, these things can so easily be miss diagnosed. What's going to happen now? :hug:

15th July 2008, 12:49 PM
Hi Fiddichs,
If you need to talk directly to some chiari patients I can arrange to put you in touch with some.I co founded the scoliosis support association of Ireland some years ago and we have some chiari patients on our messageboard.
Basically as an adult who has made it this far without diagnosis or major symptoms I can't imagine anyone rushing you for surgical intervention.
usually if children have severe neurological symptoms like loss of sensation or severe scoliosis surgeons might perform decompression or drainage of syrinxes and treat the scoliosis(spinal curvature).
With adults it's mainly a case of managing symptoms of headaches.
If it's of any interest to you I can Pm you some info.

15th July 2008, 09:28 PM
Hi All,

Thanks for the responses and if anyone has any details then it would be appreciated if you could PM on.
As I said my symptoms are not so bad and only really started to get worse in Jan which is when I ended up in hospital. I suppose I just lived with the symptoms before and got on with life so never really thought that it was anything other than headaches and dizzy spells from burning the candle at both ends. In Jan I blacked out and then a whole host of stuff started. The headaches are now constant. I have blurred vision, dizzy spells, neck ache, head tremors and so on. I would not have followed up apart from the hospital did an EEG and it came back abnormal so I got referred to a neurologist and then he started more tests.
I am lucky that they did an MRI as it would most likely have gone on for ages without a diagnosis otherwise.
I am looking positively on the fact that if I get to this age and it has not impacted me then maybe it will not progress further and I can live with it. I have got worse since Jan and my first blackout but it would have to be unbearable before I considered any form of surgery.

So any links people have would be appreciated. I have found sites in the US and UK but no details of sites in Ireland.

I am meeting with the neurologist next week to discuss further and he has mentioned a cine MRI but apart from that I will just wait and see and get on with life.