Minimally Invasive Non-Expansile Tubular Extradural Posterior Fossa Decompression (MINTED Technique) for the management of Chiari I.5 Malformation: Historical Overview of Surgical Techniques, Technical Note, Proof of Concept, Illustrative Case and Case Series. Lesser is Better

Authors

José Alberto Israel Romero Rangel, The American-British Cowdray Medical CenterFollow
Manuel Eduardo Soto García, The American-British Cowdray Medical Center IAPFollow
Sergio Soriano Solís, The American-British Cowdray Medical Center IAPFollow
Carlos Raúl Rangel Morales, National Medical Center “La Raza” Mexican Institute of Social SecurityFollow
Gerson Reyes Rodríguez, The American-British Cowdray Medical Center IAPFollow
José Antonio Soriano Sánchez, The American British Cowdray Medical Center IAPFollow

Corresponding Author

Soriano Sánchez José Antonio

Av. Carlos Graef Fernández No. 154, col. Tlaxala Santa Fe, Cuajimalpa C.P. 05300, México

Email: neurojass1@hotmail.com

Document Type

Original Research - Skull Base

Abstract

BACKGROUND: Chiari's Malformation surgical treatment has significantly changed since the "classical" technique description by Gardner (1950). It is probably the most commonly performed approach, even when multiple techniques are available because no substantial changes nor any clear surgical objectives have been made. OBJECTIVE: To demonstrate a new cutting-edge surgical technique mastering the advantage of each surgical procedure ever described in the history of Chiari's Malformation establishing three critical points in surgical technique: clear patient-specific surgical goals, dynamic posterior fossa reconstruction, and extradural occipitoatlantal dense-adhesions release. METHODS: A comprehensive review of historically described approaches, proof of concept of surgical technique in sim-station, technical note, and case series of four patients with Chiari I.5 Malformation treated by Minimally Invasive Non-expansile Tubular Extradural Decompression of the Posterior Fossa (MINTED Technique). This observational report is following the STROBE Guidelines. RESULTS: Historically comprehensive review includes 41 papers from which new surgical goals were defined. We demonstrate our experience with full pre and postoperative records and images in four patients with Chiari 1.5 malformation.

Patients presented with chronic valsalva-related symptoms associated with brainstem down-displacement on MRI with symptoms resolution and no neck disability from day zero after surgery up to 24 months follow-up. CONCLUSIONS: We demonstrate the feasibility of performing a posterior fossa decompression with the MINTED technique for Chiari 1.5 Malformation. This technique is the first full non-expansile tubular approach ever described. We redefined new and reproducible patient-specific surgical goals. This extradural technique achieves a dynamic posterior fossa reconstruction while preserving the practical midline approach familiar to every neurosurgeon worldwide. Chiari I and I.5 Malformation are best suited to benefit from the MINTED technique. Further research with randomized clinical trials will warrant its widespread use.

Completion Checklist

MAIN MANUSCRIPT DOCX; COVER LETTER; TITLE PAGE; ABSTRACT; KEYWORDS; ABBREVIATIONS; HIGHLIGHTS; AUTHOR DISCLOSURES; MANUSCRIPT; BACKGROUND; OBJECTIVE; RESULTS; DISCUSSION; CONCLUSIONS; TABLE LEGENDS; FIGURE LEGENDS; REPORTING GUIDELINES CHECKLIST; TABLES PPTX; FIGURES PPTX

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Romero Rangel, José Alberto Israel; Soto García, Manuel Eduardo; Soriano Solís, Sergio; Rangel Morales, Carlos Raúl; Reyes Rodríguez, Gerson; and Soriano Sánchez, José Antonio (2021) "Minimally Invasive Non-Expansile Tubular Extradural Posterior Fossa Decompression (MINTED Technique) for the management of Chiari I.5 Malformation: Historical Overview of Surgical Techniques, Technical Note, Proof of Concept, Illustrative Case and Case Series. Lesser is Better," Archives of Neurosurgery: Vol. 1: Iss. 1, Article 2.
Available at: https://www.ansjournal.org/home/vol1/iss1/2