Chiari Malformasyonları Cerrahi Tedavisinin Tarihçesi ve Güncel Yaklaşımlar
Özet
Santral sinir sisteminin kranial veya spinal kompartmanlarına bağlı nörolojik semptom ve bulguları olan Chiari malformasyonlarının (CM) tedavisinde özellikle tıbbı tedavi protokolleri yetersiz kaldığı hastalarda cerrahi tedavi seçeneklerine ihtiyaç vardır. CM’ların cerrahi tedavisinde amaç özellikle hastalığın patogenezini iyileşetirerek klinik ve radyolojik bulgu ve semptomların iyileşmesidir.
Yöntemler: Tip-0, I, 1.5 CM’ların cerrahi tedavisinde minimal invazif yaklaşımlardan araknoid korumalı duraplastili posterior fossa dekompresyonu (ADPFD) tekniği çoğu Nöroşirürji kliniklerinde yaygın sıklıkla uygulanmaktadır.
Sonuçlar: Chiairi malformasyonu cerrahi tedavi seçenekleri arasında minimal invazif ADPFD tekniği sonrası oluşturulan yeni yapay sisterna magnanın etrafında BOS dolanımının düzelmesiyle klinik ve radyolojik bulguların iyileşmesi tesbit edilmektedir. ADPFD minimal invazif tekniği Chiairi cerrahi tedavisinde uygulandığında kabül edilebilir postoperatif komplikasyon oranlarıyla birlikte nüks olguların mükerrer cerrahilerini de önlenmektedir.
Surgical treatment options are needed for Chiari malformations (CM), which have neurological symptoms and findings related to the cranial or spinal compartments of the central nervous system, especially in patients where medical treatment protocols are insufficient. The aim of surgical treatment of CMs is to improve clinical and radiological findings and symptoms by improving the pathogenesis of the disease.
Methods: Arachnoid-protected duraplasty posterior fossa decompression (ADPFD) technique, one of the minimally invasive approaches, is frequently applied in many Neurosurgery clinics in the surgical treatment of Type-0, I, 1.5 CMs.
Results: It is observed that clinical and radiological findings improve with the improvement of CSF (cerebrospinal fluid) circulation around the newly created artificial cisterna magna after the minimally invasive ADPFD technique among Chiari malformation surgical treatment options. When the ADPFD minimally invasive technique is applied in Chiari surgical treatment, it also prevents repeated surgeries of recurrent cases with acceptable postoperative complication rates.
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