Endoscopic foramen Magnum decompression in Chiari 1 malformation with or without syringomyelia Y R Yadav, Vijay Parihar, Shailendra Ratre, Amitesh Dubey, Pankaj Kumar Department of Neurosurgery NSCB (Government) Medical College Jabalpur MP India 482003 Recipient of Charak award (IMA MP state 2011) Chairman fellowship program of one week brain and spine endoscopic training www.neuroendoscopyjbp.org Executive member of Neurological surgeons society of India E mail yadavyr@yahoo.co.in, yadramyr@yahoo.com, Web site www.yadavyr.com Tel: +91 9893711193, +91 761 2673644.

Announcement We are starting 11 months university certified Neuroendoscopy course Last date of application is 15 Feb

Endoscopic foramen Magnum decompression in Chiari 1 malformation with or without syringomyelia Introduction: Foramen magnum decompression has been found to be safe and effective treatment in ACM without basilar invasion. Posterior fossa decompression has been described using endoscopic techniques in 2001 by Teo C et al
(Mobbs R, Teo C.Endoscopic assisted posterior fossa decompression. J Clin Neurosci. 2001 Jul;8(4):343-4. )

Indications: In ACM and ACM with syrings (Di X. Endoscopic suboccipital decompression on pediatric Chiari type I. Minim Invasive Neurosurg. 2009 Jun;52(3):119-25. doi: 10.1055/s-0029-1224170. Epub 2009 Jul 31. Deng K, Li YN, Li GL, Gao J, Yang Z, Di X, Wang RZ. Neural endoscopic assisted micro-invasive management of Chiari I malformation. Chin Med J (Engl). 2010 Jul;123(14):1878-83.
 Gao J, Yang Z, Li YN, Wang RZ. [The preliminary study of using neuro-endoscope assisted atlanto occipital decompression to treat Chiari type I malformation with syringomyelia]. Zhonghua Wai Ke Za Zhi. 2010 Oct 1;48(19):1451-3. )

Endoscopic foramen Magnum decompression in Chiari 1 malformation with or without syringomyelia Advantages: Minimal invasive nature, Fewer complications, Decreased chances of instability of bony structure, Faster recovery, Reduced hospital stay, Less expenses, Safe and effective surgical procedure

Showing pre and post op images

Showing bony decompression

Reconstructed image of bony decompression

Showing various steps of surgery

Showing partially split dura

Endoscopic foramen Magnum decompression in Chiari 1 malformation with or without syringomyelia Technique: Supine position Neck flexed Upper neck and sub-occipital area should be flat. 2-2.5 cm incision.

Endoscopic foramen Magnum decompression with C1 laminectomy in Chiari 1 malformation with or without syringomyelia Technique: Avoid C2 spine and lamina removal, Upper part of C2 may have to be drilled to position endoscopic set. Mid line marked by drilling at foramen Magnum and at C1 About 1 cm on either side is drilled at C1 About 2 cm decompression is done at foramen magnum.

Endoscopic foramen Magnum decompression with C1 laminectomy in Chiari 1 malformation with or without syringomyelia Technique: Atlanto occipital fascia is removed Outer layer of dura is split opened Any dural tear is repaired by tissue glue

References: Ratre S, Yadav N, Yadav YR, Parihar V, Bajaj J, Kher Y References: Ratre S, Yadav N, Yadav YR, Parihar V, Bajaj J, Kher Y. Endoscopic management of Arnold Chiari Malformation type 1 with or without syringomyelia. J Neurol Surg A Cent Eur Neurosurg in press.

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