This document discusses the surgical treatment of Chiari I decompression. It outlines the indications for surgery as symptoms of pain, limb weakness, and balance issues or signs like hyperactive reflexes. It describes the surgical positioning and options for dural flaps or scoring. Post-operative complications may include CSF leak, pseudomeningocele, cerebellar ptosis, or injury to blood vessels. Most patients experience pain relief after surgery, while weakness is less responsive. The best management of a post-operative pseudomeningocele is oversewing the site with a lumbar drain and head elevation.

1. Start with the Great name of ALLAH, the most merciful and beneficial

2. Chiari I Decompression
Dr Zeeshan

3. Radiology

4. Surgical
treatment

5. Indications
 Symptoms: pain, 1 or >1 limb weakness, balance
difficulties
 Signs: Hyperactive lower extremities reflex, downbeat
nystagmus, hand muscle atrophy, Cerebellar signs &
babinski sign

6. Position

25. Flapoptions  Pericranium, fascia lata and allograft dura

26. Alternativeto
Duroplasty
 Removal of extra dural bands, intraoperative USG to
verify the flow in central canal
 Partial Thickness scoring of dura with Several parallel
passes of scalpel.

27. Closure
 Multilayered water tight closure
 Suture preferable
 Wound drain not used
 Sometimes Lumber drain may be used For 2 to 3 days

28. Complications
 CSF leak ; treated with Lumber drain with over sewing
the site of leak
 Subcutanous Pseudomeningocele
 Cerebellar Ptosis
 Injury to PICA
 Post op apnea in pediatric age

29. Outcome
 82 % pain Relive with four year followup
 Weakness less responsive to surgery
 Worse prognosis of patient with greater than 2 years
symptoms
 Syringx resolves in majority of patients

30. Question
 Three years after suboccipital crainectomy with
Duroplasty for symptomatic CMI, patient developed
tense, very painful Cyst swelling Under the incision.
MRI shows Pseudomeningocel. What will be best
course of management.
 Cyst aspiration with crab bandage
 Lumber drain placement with flat posture for 3 days
 Oversewing with Lumber drain and head elevation
over 30 degree.
 Placement of EVD then convert it to shunt if patient
becomes drain dependent

31. Answer  Oversewing with Lumber drain