Respiratory Hazards of the Surgical Treatment of the Arnold-Chiari Malformation

T HE risks a t t e n d i n g surgical decompres sion of the pos te r ior fossa and of the uppe r cervical cord in cases of Arno ld Chiar i ma l fo rma t ion are well known. A careful study of some of t he m a n y excel lent ear ly papers on the sub jec t 1-3 will show t h a t in those ins tances when the ope ra t ion consis ted of b o n y and dura l decompress ion only , t he resul ts were excellent , b u t when exp lora t ion of t he pos te r io r fossa was added , when neura l t issue was incised, excised or s epa ra t ed , when the du ra m a t e r was incomple t e ly opened or when i t was closed a t the end, the resul ts were poor. I n fact a m o r t a l i t y figure of 60 per cent was no t unusua l a t t h a t period. D e a t h in all ins tances resul ted f rom r e s p i r a t o r y d i f f cu l ty which somet imes commenced dur ing the opera t ion itself. One r e s p i r a t o r y haza rd to which these papers do no t d r a w a t t e n t i o n is t ha t occasioned b y the pos i t ion of the pat i en l ' s head dur ing the opera t ion-a difficu l ty t h a t we have encoun te red on 3 occasions and which forms the sub jec t of th is communica t ion .