Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Introduction: In the early 1890s, the pathologist hans chiari described four congenital malformations that would later become known as the Chiari malformations. The arnold chiari malformation (chiari-2) is a congenital abnormality of the hindbrain characterized by a smaller than normal posterior cranial fossa with downward displacement of the vermis, brainstem, and fourth ventricle into the foramen magnum and the cervical spinal canal. This type is found in all patients with myelomeningocele. Objective: To detect the best surgical option for treatment of arnold chiari malformation (chiari type 2). (a) Shunt of the hydrocephalus first. (b) Repair of myelomeningocele first. (c) Shunt of the hydrocephalus and repair of myelomeningocele in one operative setting. Patients and methods: This study included 30 patients with Chiari malformation type 2 operated in the period between January2015 to June 2016 at the Neurosurgery department of Kasr Elaini Cairo university hospitals. Data were collected prospectively from the patients involved in the study. All patients were evaluated preoperatively by neurological, ophthalmological and radiological assessment. All patients underwent evaluation by, CT scanning of the brain and skull and MRI imaging of the brain. Follow up CT was done before hospital discharge for all patients. Extra scans were done for any deteriorating patient. Conclusion: Children who are having combined myelomeningocele and hydrocephalus can be treated by one stage or two stage procedure with equal safety with shorter hospital stay for those treated in the same session

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