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| Research article summary (published 27 Feb 2003): |
Improvement in brainstem auditory evoked potentials after suboccipital decompression in patients with chiari I malformations.
Full Abstract
OBJECT:
The optimal treatment for patients with symptoms related to Chiari I malformation remains controversial. Although a suboccipital decompression with duraplasty is most commonly performed, there may be a subset of patients who improve in response to bone decompression alone. In an initial attempt to identify such patients, we performed a continuous study of intraoperative brainstem auditory evoked potentials (BAEPs) in patients undergoing a standard decompression with duraplasty and compared conduction times at three different time points:
1) baseline while the patient is supine (before positioning); 2) immediately after opening of the bone and release of the atlantooccipital membrane (that is, the dural band); and 3) after opening of the dura mater.
METHODS:
Eleven children and young adults (mean age 9.8 years) with symptoms related to Chiari I malformation underwent suboccipital decompression and duraplasty with intraoperative monitoring of BAEPs and somatosensory evoked potentials (SSEPs). Six patients (55%) had associated syringomyelia. At baseline, the I to V interpeak latency (IPL) for both sides (total 21 BAEPs) was 4.19 +/- 0.22 msec (mean +/- standard deviation). After complete bone decompression and before the dura mater was opened, the I to V IPL decreased to 4.03 +/- 0.25 msec (p = 0.0005). When the dura was opened, however, no further decrease in the I to V IPL was detected (4.03 +/- 0.25 msec; p = 0.6). The SSEPs remained stable throughout the procedure.
CONCLUSIONS:
In children and young adults undergoing suboccipital decompression with duraplasty for Chiari I malformation, the vast majority of improvement in conduction through the brainstem occurs after bone decompressionand division of the atlantooccipital membrane, rather than after opening of the dura. Additional studies are needed to establish whether the improvement seen with BAEP monitoring during bone decompression will predict long-term clinical improvement in these patients.
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Author information
Author/s: Anderson, Richard C E (RC); Emerson, Ronald G (RG); Dowling, Kathryn C (KC); Feldstein, Neil A (NA);
Affiliation: Department of Neurosurgery, The Neurological Institute, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Journal and publication information
Publication Type: Journal Article
Journal: Journal of neurosurgery (J Neurosurg), published in United States. (Language: eng)
Reference: 2003-Mar; vol 98 (issue 3) : pp 459-64
Dates: Created 2003/03/24; Completed 2003/04/02; Revised 2004/11/17;
PMID: 12650414, status: MEDLINE (last retrieval date: 11/6/2008)
Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.
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