Impacts of type 1 Chiari malformation on elderly.

Abstract

Background: This study aims to evaluate the surgical outcomes of elderly patients with Chiari malformation (CM) who underwent suboccipital craniectomy (SC) with duraplasty (DP) or dural splitting (DS). The focus is on symptom relief, changes in syrinx size, hospital admission duration, and postoperative complications.

Methods: A retrospective study was performed to evaluate the outcomes of elderly CM patients who underwent SC with DP or dural splitting (DS). Patients older than 60 years who underwent posterior fossa decompression (PFD) together with DP or DS who underwent surgery from 1989 to 2022 were included in the study. Patients were divided into two categories based on their surgical approach - SC with DP and SC with dural splitting (DS) surgery. Demographic details, co-morbidities, clinical features, management details, Chicago Chiari Outcome Scale (CCOS), complications, and follow-up details were obtained.

Results: Of the seven patients, five were females, and two were males. The mean age at the time of the operation is 65.14 years. Among the seven patients, six had syrinx, with a mean diameter of 6.17 mm; one patient had hydrocephalus, and one had scoliosis. All the patients underwent PFD; six patients also underwent DP, and one patient underwent DS. The median CCOS at the time of discharge is 13.

Conclusion: In elderly CM patients, surgery improved symptoms for most but led to reoperations in two cases. Despite a slight increase in syrinx diameter and a drop in the CCOS score, better outcomes were associated with smaller syrinxes. Further research is needed to optimize treatment strategies for this population.