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Keser N, Omar MB, Kalyoncu Aslan I, Bodur I, Demirgil BT. Unresponsiveness to Chiari Malformation Type I Surgery Can Be Related to the Accompanying Chiari Network. Cureus 2024; 16:e60896. [PMID: 38800777 PMCID: PMC11116738 DOI: 10.7759/cureus.60896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
Surgical treatment is indicated for Chiari malformation type 1 (CMI) with tonsillar descent (TD) of >5 mm and other clinical manifestations. However, some patients remain unresponsive to surgery; this is an active topic of discussion. A patient presented to the emergency department with dizziness and an impaired gait. He had a history of hypertension. Magnetic resonance investigations revealed a 9-mm TD and cervical syringomyelia. There was no evidence of interatrial septum pathology on transthoracic echocardiography performed preoperatively. Although his complaints were attributed to CMI and surgery was performed, his symptoms remained persistent. Two years later, when the patient's dizziness increased, a posterior fossa transient ischemic attack (TIA) was suspected. A large patent foramen ovale (PFO) and Chiari network (CN) were also detected on transesophageal echocardiography. His complaints were resolved following PFO closure. Our case suggests that neurosurgeons should be informed about the results of the companionship of a PFO and CN. Before deciding on CMI surgery for patients with only dizziness complaints, a detailed investigation of accompanying cardiac pathologies is paramount to ensure accurate diagnosis and treatment.
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Affiliation(s)
- Nese Keser
- Department of Neurosurgery, University of Health Sciences, Medical Faculty of Hamidiye, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, TUR
| | - Muhammed B Omar
- Department of Cardiology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Isil Kalyoncu Aslan
- Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR
| | - Ipek Bodur
- Department of Neurosurgery, University of Health Sciences, Medical Faculty of Hamidiye, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, TUR
| | - Bulent T Demirgil
- Department of Neurosurgery, University of Health Sciences, Medical Faculty of Hamidiye, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, TUR
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Clarke JE, Reyes JM, Luther E, Govindarajan V, Leuchter JD, Niazi T, Ragheb J, Wang S. Chiari I malformation management in patients with heritable connective tissue disorders. World Neurosurg X 2023; 18:100173. [PMID: 36969375 PMCID: PMC10031113 DOI: 10.1016/j.wnsx.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Background Chiari malformation type I (CMI) is relatively common neurosurgical condition typically treated with posterior fossa decompression. However, the management of CMI in patients with heritable connective tissue disorders (CTDs), such as Ehlers-Danlos Syndrome, Marfan Syndrome, or Osteogenesis Imperfecta, involves a unique set of perioperative challenges. Objective This study aims to define the demographic information, comorbidities, and perioperative course of patients with concomitant CMI and CTD. Methods Patients with CMI admitted for surgical decompression from 2008 to 2015 were captured using the National Inpatient Sample (NIS). Information was collected based on ICD-9 codes. Descriptive and regression analyses were performed in SPSS (version 26). Results 38,169 CMI patients, 353 of whom had CTD (0.92%), were identified. CMI patients with CTD were more likely to be female (p < 0.001) and present during teenage (p = 0.033) or young adult years (p < 0.001). They had more chronic issues (p < 0.001): systemic comorbidities include postural orthostatic tachycardia syndrome, cardiac dysrhythmias, and gastroparesis (all p < 0.001). CNS comorbidities include migraine, tethered spinal cord, and epilepsy (all p < 0.001). They have increased joint instability (both p < 0.001), as well as craniocervical instability (CCI). More posterior cervical fusion surgeries and application of cervical halo devices were seen during the same inpatient stay (both p < 0.001). Conclusions Patients with concurrent CTD and CMI were more likely to present with complex Chiari and associated CCI. They were also younger, more often female, and had more systemic, CNS, and joint abnormalities. As such, preoperative recognition of an underlying CTD is imperative to achieve optimal outcomes in this patient population.
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Yang X, Zeng J, Gu Y, Fang Y, Wei C, Tan S, Zhang X. Birth defects data from hospital-based birth defect surveillance in Guilin, China, 2018-2020. Front Public Health 2022; 10:961613. [PMID: 36091541 PMCID: PMC9449144 DOI: 10.3389/fpubh.2022.961613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Objectives Birth defects (BDs) are a major contributor to perinatal and infant mortality, morbidity and lifelong disability worldwide. A hospital-based study on birth defects was designed in Guilin city in the Guangxi province of Southwestern China aiming to determine the prevalence of BDs in the studied region, and the classify the BDs based on clinical presentation and causation. Methods The study involved BDs among all pregnancy outcomes (live births, stillbirths, death within 7 days, and pregnancy terminations) born in the 42 registered hospitals of Guilin between 2018 and 2020. The epidemiological characteristics of BDs and the etiologic profile of BDs were evaluated in this study. Results Of the total 147,817 births recorded during the study period, 2,003 infants with BDs were detected, giving a total prevalence rate of 13.55 per 1,000 births. The top five BD types were congenital heart defects, polydactyly, syndactyly, malformations of the external ear, and talipes equinovarus, whereas, neural tube defects, congential esophageal atresia, gastroschisis, extrophy of urinary bladder, were the least common BD types in these 3 years. Only 8.84% of cases were assigned a known etiology, while most cases (91.16%) could not be conclusively assigned a specific cause. Conclusion This study provides an epidemiological description of BDs in Guilin, which may be helpful for understanding the overall situation in Southwest China of BDs and aid in more comprehensive studies of BDs in future healthcare systems, including funding investment, policy-making, monitor, prevention. Strong prevention strategies should be the priority to reduce BDs and improve the birth quality.
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Affiliation(s)
- Xingdi Yang
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China
| | - Jianjuan Zeng
- Department of Child Health Care, Guilin Maternal and Child Health Hospital, Guilin, China
| | - Yiping Gu
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China
| | - Yiming Fang
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China
| | - Caiyun Wei
- Public Health, Guilin Medical University, Guilin, China
| | - Shengkui Tan
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China,*Correspondence: Shengkui Tan
| | - Xiaoying Zhang
- Public Health, Guilin Medical University, Guilin, China,The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, China,Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin, China,Xiaoying Zhang
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