Introduction: Chiari I malformation (CIM) is a congenital abnormality defined as downward herniation of the cerebellar tonsils through the foramen magnum. Syringomyelia is present in 30–85% of cases. Magnetic resonance (MR) imaging has increased the frequency of diagnosis of this complex disorder. Great variety exists in the indications and techniques recommended for the surgical management of this complex. Methods: In a group of 23 prospectively selected patients (15 males and 8 females) having (CIM) with and without syringomyelia (11 patients and 12 patients respectively) during a five years period from January, 2005 to January, 2010. Cranio-cervical bony decompression alone was done in 8 patients, Cranio-cervical bony decompression with duroplasty was done in 12 patients, and Cranio-cervical bony decompression with syringo-subarachnoid shunt was done in three patients. Outcome was defined as good, fair, or bad. Results: During a mean follow-up period of 32 months, the overall outcome was good in 19 patients (83%), fair in 3 patients (13%), and bad in one patient (4%). No operative mortality or permanent post operative morbidity was encountered. Transient post operative morbidity was encountered in 6 patients (26%) namely mild temporary neurological deterioration, CSF leak, and mild wound sepsis. There were no statistically significant differences between the various decompressive approaches. Conclusion: Decompression of the cranio-cervical junction through suboccipital craniectomy (SOC) with cervical laminectomy, duroplasty, or syringo-subarachnoid shunt is the recommended surgical management option for CIM±S. Further studies utilizing larger patient volumes are necessary to confirm our recommendation.

Introduction: Chiari I malformation (CIM) is a congenital abnormality defined as downward herniation of the cerebellar tonsils through the foramen magnum. Syringomyelia is present in 30–85% of cases. Magnetic resonance (MR) imaging has increased the frequency of diagnosis of this complex disorder. Great variety exists in the indications and techniques recommended for the surgical management of this complex. Methods: In a group of 23 prospectively selected patients (15 males and 8 females) having (CIM) with and without syringomyelia (11 patients and 12 patients respectively) during a five years period from January, 2005 to January, 2010. Cranio-cervical bony decompression alone was done in 8 patients, Cranio-cervical bony decompression with duroplasty was done in 12 patients, and Cranio-cervical bony decompression with syringo-subarachnoid shunt was done in three patients. Outcome was defined as good, fair, or bad. Results: During a mean follow-up period of 32 months, the overall outcome was good in 19 patients (83%), fair in 3 patients (13%), and bad in one patient (4%). No operative mortality or permanent post operative morbidity was encountered. Transient post operative morbidity was encountered in 6 patients (26%) namely mild temporary neurological deterioration, CSF leak, and mild wound sepsis. There were no statistically significant differences between the various decompressive approaches. Conclusion: Decompression of the cranio-cervical junction through suboccipital craniectomy (SOC) with cervical laminectomy, duroplasty, or syringo-subarachnoid shunt is the recommended surgical management option for CIM±S. Further studies utilizing larger patient volumes are necessary to confirm our recommendation.

Introduction: Chiari I malformation (CIM) is a congenital abnormality defined as downward herniation of the cerebellar tonsils through the foramen magnum. Syringomyelia is present in 30–85% of cases. Magnetic resonance (MR) imaging has increased the frequency of diagnosis of this complex disorder. Great variety exists in the indications and techniques recommended for the surgical management of this complex. Methods: In a group of 23 prospectively selected patients (15 males and 8 females) having (CIM) with and without syringomyelia (11 patients and 12 patients respectively) during a five years period from January, 2005 to January, 2010. Cranio-cervical bony decompression alone was done in 8 patients, Cranio-cervical bony decompression with duroplasty was done in 12 patients, and Cranio-cervical bony decompression with syringo-subarachnoid shunt was done in three patients. Outcome was defined as good, fair, or bad. Results: During a mean follow-up period of 32 months, the overall outcome was good in 19 patients (83%), fair in 3 patients (13%), and bad in one patient (4%). No operative mortality or permanent post operative morbidity was encountered. Transient post operative morbidity was encountered in 6 patients (26%) namely mild temporary neurological deterioration, CSF leak, and mild wound sepsis. There were no statistically significant differences between the various decompressive approaches. Conclusion: Decompression of the cranio-cervical junction through suboccipital craniectomy (SOC) with cervical laminectomy, duroplasty, or syringo-subarachnoid shunt is the recommended surgical management option for CIM±S. Further studies utilizing larger patient volumes are necessary to confirm our recommendation.

SICH during childhood is rare and often devastating event. The objective of this study was to highlight the etiology, demography, hemorrhagic type, clinical features, treatment options and outc Sixty nine consecutive patients of SICH aged 18 years and below were retrospec¬tively analyzed based on clinical data and radiographic images in regard to their age, sex, symptoms, radiologic findings, treatment and ou Age of patients ranged from one month to 18 years with higher predilection in males (M: F = 1.4:1). Presenting features were symptoms of raised intracranial pressure (43%), deterioration in conscious level (28%), limb weakness (17%) and seizures (12%). In our series hematological disorders was the most common cause of hemorrhage, and was found in 34 patients (49%), followed by Arteriovenous malformations (AVMs) in 23 patients (33%), intracranial tumor in 4 patients (6% ), unknown cause in 4 patients (6%), CNS infection in 2 patients (3%) and intracranial aneurysm in 2 patients (3%). Treatment modalities consisted of: hematoma evacuation, excision, embolization or radiosurgery of AVMs, aneurysm clipping, tumor excision and conservative managem

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