第38回日本小児神経外科学会
The 38th Annual Meeting of the Japanese Society for Pediatric Neurosurgery

前の演題

第1日目、6月4日(金)A 会場(3階 メインホール)18:00〜19:00

イブニングセミナー

座長: 田代 弦

EV-2

Chiari malformation: theory-based treatment from maximal to minimal.

Mark G. Luciano

Section of Pediatric and Congenital Neurosurgery, CSF Physiology Laboratory, Aging Brain Clinic

The treatment of Chiari Malformation has varied greatly from tonsillectomy and radical posterior cranial reconstruction to minimal bony decompression. Selection of the surgical approach has been governed more by the prevailing etiological theory and much less by direct comparison of approaches. Etiological theories have included obstructed CSF flow, tethered cord, underdeveloped posterior fossa, neuronal shear stress and anterior compression. Approaches such obex plugging, tonsillectomy, cranial vault reconstruction, tether cord release, spinal fusion and minimal boney resection all have roots in these particular theories. In general, the trend in the last decades has been towards less invasive procedures and the minimal approaches have led to the possibility of fully endoscopic bony decompressions via minimal soft tissue disruption and small incisions. While such procedures can result in low morbidity and quick recovery time, concerns exist as to whether minimal procedures are adequate, lasting and address the important pathological features.

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