Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation

Kalb, Samuel; Pérez-Orribo, Luis; Mahan, Mark A.; Theodore, Nicholas; Nakaji, Peter; Bristol, Ruth E.

doi:10.1016/j.jocn.2012.01.025

Cited by 45 publications

(44 citation statements)

References 38 publications

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“…Since at least 1976, multiple groups have tried to predict which CM-1 patients are most likely to benefit from surgery, 9–13, 27–29 and in 1995, Bindal and colleagues proposed a classification system that categorized patients based on the presence of syringomyelia and signs of brainstem compression. 11 However, the proposed categories provided limited detail, and with only 27 patients, this study had little power to develop or evaluate a grading system.…”

Section: Discussionmentioning

confidence: 99%

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The Chiari Severity Index

et al. 2015

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Background To develop evidence-based treatment guidelines for Chiari Malformation Type 1 (CM-1), preoperative prognostic indices capable of stratifying patients for comparative trials are needed. Objective To develop a preoperative Chiari Severity Index (CSI) integrating the clinical and neuroimaging features most predictive of long-term patient-defined improvement in quality of life (QOL) after CM-1 surgery. Methods We recorded preoperative clinical (e.g. headaches, myelopathic symptoms) and neuroimaging (e.g. syrinx size, tonsillar descent) characteristics. Brief follow-up surveys were administered to assess overall patient-defined improvement in QOL. We used sequential sequestration to develop clinical and neuroimaging grading systems and conjunctive consolidation to integrate these indices to form the CSI. We evaluated statistical significance using the Cochran-Armitage test and discrimination using the c-statistic. Results Our sample included 158 patients. Sequential sequestration identified headache characteristics and myelopathic symptoms as the most impactful clinical parameters, producing a clinical grading system with improvement rates ranging from 81% (grade 1) to 58% (grade 3) (p=0.01). Based on sequential sequestration, the neuroimaging grading system included only the presence (55% improvement) or absence (74% improvement) of a syrinx ≥ 6 mm (p=0.049). Integrating the clinical and neuroimaging indices, improvement rates for the CSI ranged from 83% (grade 1) to 45% (grade 3) (p=0.002). The combined CSI had moderately better discrimination (c=0.66) than the clinical (c=0.62) or neuroimaging (c=0.58) systems alone. Conclusion Integrating clinical and neuroimaging characteristics, the CSI is a novel tool that predicts patient-defined improvement following CM-1 surgery. The CSI may aid preoperative counseling and stratify patients in comparative effectiveness trials.

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Section: Discussionmentioning

confidence: 99%

“…In addition, previous investigations evaluated outcome based on medical record review, which may not adequately reflect patient perspectives of their symptomatic improvement. 9–12, 27–29 …”

Section: Discussionmentioning

confidence: 99%

The Chiari Severity Index

et al. 2015

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“…It has been suggested that headache is the most common symptom of CIM, particularly in the paediatric population 3 8 11 12. Furthermore, CIM may be an organic cause of headache in children with medically refractory headaches.…”

Section: Introductionmentioning

confidence: 99%

Headache outcomes in children undergoing foramen magnum decompression for Chiari I malformation

et al. 2017

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“…Of these, Chairi Malformation type I (CM1) is the most benign, limited to crowding of the foramen magnum secondary to herniation of the cerebellar tonsils sometimes causing obstructive hydrocephalus or syringomyelia. 100,[104][105][106] The natural history of CM1 is largely benign. 102,103 The number of new CM1 diagnoses is rising as the rate of MRI studies in children rises.…”

Section: Chiari Malformation Type Imentioning

confidence: 99%

The Surgical Treatment of Headache

Hong

Roberts

2014

Headache

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Medically refractory headache is an uncommon but difficult-to-treat clinical problem. Patients who fail maximal medical management may be candidates for invasive treatment. In this review, we critically examine the literature on the range of surgical treatments currently available for migraine, trigeminal autonomic cephalalgias, idiopathic intracranial hypertension and Chiari malformation type 1, with particular attention to patient selection, treatment efficacy, and complications.

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Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation

Cited by 45 publications

References 38 publications

The Chiari Severity Index

The Chiari Severity Index

Headache outcomes in children undergoing foramen magnum decompression for Chiari I malformation

The Surgical Treatment of Headache

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