Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Case Report Volume 8 Issue 6

Posterior Fossa Decompression By Biportal Endoscopy In a Patient With Chiari Malformation, Case Report and Description of the Surgical Technique

Nadya Arely Méndez Reyes1, Malcolm Pestonji2, Antonio Sosa Nájera3 Rodolfo Guerrero Peréz4*

1Department of Neurosurgery, San José Hospital, Celaya, Guanajuato, México
2Department of Orthopedic Surgery, Golden Park Hospital and Endoscopic Spine Foundation India, Vasai West, Thane 401202, Maharashtra, India
3Department of Neurosurgery at the Angeles Hospital in Morelia, México
4Department of Neurosurgery, San José Hospital, Celaya, Guanajuato, México

*Corresponding Author: Rodolfo Guerrero Perez MD, Department of Neurosurgery, San José Hospital, Celaya, Guanajuato, México.

Received: May 16, 2025; Published: May 29, 2025

Abstract

The advent of endoscopy in medicine has allowed us to visualize and magnify anatomical structures in real time, allowing for safer and less invasive surgical procedures. We describe the biportal endoscopy surgical technique for posterior fossa decompression, craniocervical junction and resection of the posterior C1 arch, as a viable option within the minimally invasive techniques in the treatment of Chiari malformation.

Keywords: Posterior fossa; Decompression; Biportal endoscopy; Chiari malformation

References

  1. Bejjani GK. “Definition of the adult Chiari malformation: a brief historical overview”. Neurosurgical Focus1 (2001): E1.
  2. Alden TD., et al. “Surgical treatment of Chiari I malformation: indications and approaches”. Neurosurgical Focus1 (2001): E2.
  3. Tubbs R Shane., et al. “A new form of herniation: the Chiari V malformation”. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery2 (2012): 305-307.
  4. Wilkins RH and IA Brady. “The Arnold-Chiari malformations”. Archives of Neurology4 (1971): 376-379.
  5. Olszewski Adam M and Mark R Proctor. “Headache, Chiari I malformation and foramen magnum decompression”. Current Opinion in Pediatrics6 (2018): 786-790.
  6. Russell GE., et al. “Arnold-Chiari malformation”. Optometry and Vision Science : Official Publication of the American Academy of Optometry3 (1992): 242-247.
  7. Morgenstern Peter F., et al. “Ventrolateral Tonsillar Position Defines Novel Chiari 0.5 Classification”. World Neurosurgery 136 (2020): 444-453.
  8. Tubbs R Shane., et al. “Chiari IV malformation: correcting an over one century long historical error”. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery7 (2016): 1175-1179.
  9. Fisahn Christian., et al. “The Chiari 3.5 malformation: a review of the only reported case”. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery 32,12 (2016): 2317-2319.
  10. Hidalgo Joaquin A., et al. “Arnold-Chiari Malformation”. StatPearls, StatPearls Publishing (2023).
  11. Chuang Ya-Chen., et al. “Multi-Dimensional Morphometric and Volumetric Analysis of the Posterior Cranial Fossa to Study Type I Chiari Malformation”. World Neurosurgery 191 (2024): e279-e288.
  12. Shuman William H., et al. “Is there a morphometric cause of Chiari malformation type I? Analysis of existing literature”. Neurosurgical Review1 (2022): 263-273.
  13. Arnautovic Aska., et al. “Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes”. Journal of Neurosurgery. Pediatrics2 (2015): 161-177.
  14. Mortazavi Armin., et al. “Multicenter comparison of Chiari malformation type I presentation in children versus adults”. Journal of Neurosurgery. Pediatrics1 (2024): 49-56.
  15. Strayer A. “Chiari I malformation: clinical presentation and management”. The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses2 (2001): 90-96.
  16. Mancarella Cristina., et al. “Chiari Malformations”. Acta Neurochirurgica. Supplement 125 (2019): 89-95.
  17. Bordes Stephen., et al. “Defining, diagnosing, clarifying, and classifying the Chiari I malformations”. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery10 (2019): 1785-1792.
  18. Levy WJ., et al. “Chiari malformation presenting in adults: a surgical experience in 127 cases”. Neurosurgery 4 (1983): 377-390.
  19. Giammattei Lorenzo., et al. “Chiari I malformation: surgical technique, indications and limits”. Acta Neurochirurgica 1 (2018): 213-217.
  20. Klekamp J., et al. “The surgical treatment of Chiari I malformation”. Acta Neurochirurgica7 (1996): 788-801.
  21. Tubbs R Shane and W Jerry Oakes. “Treatment and management of the Chiari II malformation: an evidence-based review of the literature”. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery6 (2004): 375-381.
  22. James Hector E and Adam Brant. “Treatment of the Chiari malformation with bone decompression without durotomy in children and young adults”. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery5 (2002): 202-206.
  23. Chotai Silky and Azedine Medhkour. “Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I”. Clinical Neurology and Neurosurgery 125 (2014): 182-188.
  24. James Hector E and Adam Brant. “Treatment of the Chiari malformation with bone decompression without durotomy in children and young adults”. Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery5 (2002): 202-206.
  25. McClugage Samuel G and W Jerry Oakes. “The Chiari I malformation”. Journal of Neurosurgery Pediatrics3 (2019): 217-226.
  26. Park JK., et al. “Presentation and management of Chiari I malformation in children”. Pediatric Neurosurgery4 (1997): 190-196.
  27. Dyste GN., et al. “Symptomatic Chiari malformations. An analysis of presentation, management, and long-term outcome”. Journal of Neurosurgery2 (1989): 159-68.
  28. Dolas I., et al. “Full-endoscopic technique for posterior fossa decompression in Chiari malformation type I: An anatomical feasibility study in human cadavers”. Clinical Anatomy (New York, N.Y.)4 (2023): 660-668.
  29. Dolas Ilyas., et al. “Full-Endoscopic Technique for Posterior Fossa Decompression in Chiari Malformation”. Operative Neurosurgery (Hagerstown, Md.)6 (2023): e345-e351.
  30. Di X. “Endoscopic suboccipital decompression on pediatric Chiari type I”. Minimally Invasive Neurosurgery: MIN3 (2009): 119-125.
  31. Deng Kan., et al. “Neural endoscopic assisted micro-invasive management of Chiari I malformation”. Chinese Medical Journal14 (2010): 1878-1883.
  32. Mobbs R and C Teo. “Endoscopic assisted posterior fossa decompression”. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia4 (2001): 343-344.
  33. Choi Chang Myong., et al. “How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis”. Acta Neurochirurgica 3 (2016): 459-463.
  34. Eun Sang Soo., et al. “Biportal Endoscopic Lumbar Decompression for Lumbar Disk Herniation and Spinal Canal Stenosis: A Technical Note”. Journal of Neurological Surgery. Part A, Central European Neurosurgery 4 (2017): 390-396.
  35. Zhang Kaiping., et al. “Developing the surgical technique reporting checklist and standards: a study protocol”. Gland Surgery8 (2021): 2591-2599.
  36. Hong Young-Ho., et al. “Water Dynamics in Unilateral Biportal Endoscopic Spine Surgery and Its Related Factors: An In Vivo Proportional Regression and Proficiency-Matched Study”. World Neurosurgery 149 (2021): e836-e843.
  37. Antkowiak Lukasz., et al. “External validation of the Chicago Chiari Outcome Scale in adults with Chiari malformation type I”. Neurosurgical Focus3 (2023): E3.
  38. Sclafani Joseph A and Choll W Kim. “Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review”. Clinical Orthopaedics and Related Research6 (2014): 1711-1717.
  39. Teo KA., et al. “Minimally-invasive approach to posterior fossa decompression: Initial experience in Adult Chiari Type 1 Malformation patients”. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia 56 (2018): 90-94.
  40. Pakzaban Peyman. “Technique for Mini-open Decompression of Chiari Type I Malformation in Adults”. Operative Neurosurgery (Hagerstown, Md.)4 (2017): 465-470.
  41. Ratre Shailendra., et al. “Endoscopic Management of Arnold-Chiari Malformation Type I with or without Syringomyelia”. Journal of Neurological Surgery. Part A, Central European Neurosurgery1 (2018): 45-51.
  42. Günerhan Göksal. “A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I”. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society8 (2024): 3049-3059.

Citation

Citation: Rodolfo Guerrero Peréz.,et al. “Posterior Fossa Decompression by Biportal Endoscopy in a Patient with Chiari Malformation, Case Report and Description of the Surgical Technique".Acta Scientific Neurology 8.6 (2025): 33-41.

Copyright

Copyright: © 2025 Rodolfo Guerrero Peréz.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate32%
Acceptance to publication20-30 days

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.

Contact US