Intraoperative Neurophysiologic Monitoring for Prediction of Postoperative Neurological Improvement in a Child With Chiari Type I Malformation

Kawasaki, Yukari; Uchida, Susumu; Onishi, Kouhei; Toyokuni, Masako; Okanari, Kazuo; Fujiki, Minoru

doi:10.1097/scs.0000000000003926

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…These should not be considered firstline examinations and their role in the diagnosis and evaluation of CM1 is unproven. Additionally, in spite of their utility in case of brainstem or spinal cord involvement, their role in the intraoperative monitoring at the moment of positioning and during the posterior fossa decompression remains controversial [ 41 , 42 ]. Polysomnography is indicated to confirm the diagnosis of sleep apneas at any age, in particular in infants and small children with significant overcrowding of the posterior fossa.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

et al. 2021

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Background Chiari malformation type 1 (CM1) is a rare condition where agreed classification and treatment are still missing. The goal of this study is to achieve a consensus on the diagnosis and treatment of CM1 in children. Methods A multidisciplinary panel formulated 57 provisional statements based on a review of the literature. Thirty-four international experts (IE) participated in a Delphi study by independently rating each statement on a 4-point Likert scale (“strongly disagree,” “disagree,” “agree,” “strongly agree”). Statements that were endorsed (“agree” or “strongly agree”) by < 75% of raters were re-formulated, or new statements were added, and another Delphi round followed (up to a maximum of three). Results Thirty-five IE were contacted and 34 agreed to participate. A consensus was reached on 30/57 statements (52.6%) after round 1. Three statements were added, and one removed. After round 2, agreement was reached on 56/59 statements (94.9%). Finally, after round 3, which took place during the 2019 Chiari Consensus Conference (Milan, Italy), agreement was reached on 58/59 statements (98.3%) about four main sections (Definition and Classification, Planning, Surgery, Isolated Syringomyelia). Only one statement did not gain a consensus, which is the “definition of radiological failure 24 month post-surgery.” Conclusions The consensus document consists of 58 statements (24 on diagnosis, 34 on treatment), serving clinicians and researchers following children with CM1. There is a clear need for establishing an international network and registry and to promote collaborative studies to increase the evidence base and optimize the long-term care of this patient population.

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Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

et al. 2021

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“…Another important aspect provided by intraoperative monitoring concerns variation on motor and somatosensory evoked potentials' curves. Kawasaki Y, et al have found improvement in the potentials' curves during decompression in Chiari type I malformation decompressive surgery as a good indicator for clinical recovery [32]. We believe that this knowledge could also be useful during skeletal C0-C1 decompression surgery from skeletal dysplasia with foramen magnum and upper cervical stenosis.…”

Section: Discussionmentioning

confidence: 60%

Decompressive Surgery for Craniovertebral Foramen Magnum Stenosis with Medullary Compression in Paediatric Skeletal Dysplasia Syndromes

Antunes¹,

Pereira²,

Daniela³

et al. 2021

Neurosurg Cases Rev

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“…15,17 Some show that IONM may be useful to determine the efficacy of decompression, assess the risk of neurological injury, and prevent complications from manipulation of the craniocervical junction. 15,18,19 The association between radiologic imaging of CM-I patients and IONM findings is inconsistent. One study found no relationship between the extent of CM-I tonsillar ectopia and intraoperative brain stem auditory evoked potentials.…”

Section: Discussionmentioning

confidence: 99%

Use of Intraoperative Neuromonitoring in Surgical Treatment of Acute Presentation of Chiari I Malformation: A Case Report

Vazquez

Auerbach-Tash

et al. 2023

J Neurol Surg Rep

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Intraoperative neuromonitoring (IONM) has been used in neurosurgical procedures to assess patient safety and minimize risk of neurologic deficit. However, its use in decompressive surgeries of Chiari Malformation Type I (CM-I) remains a topic of debate. Here we present the case of a 5 year old female who presented with acute right lower extremity monoplegia after accidental self-induced hyperflexion of the neck while playing. Imaging revealed 15 millimeters of tonsillar ectopia with cervical and upper thoracic spinal cord edema. She was taken to surgery for a suboccipital decompression with expansile duraplasty. IONM demonstrated improvement in motor evoked potentials during the decompression. Postoperatively, she had full recovery of strength and mobility. This is a case of acute weakness after mild trauma in the setting of previously asymptomatic CM-I that showed close correlation with IONM, clinical findings, and imaging. IONM during decompressive surgery for CM-I may be useful in patients that present acutely with cervical cord edema.

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Intraoperative Neurophysiologic Monitoring for Prediction of Postoperative Neurological Improvement in a Child With Chiari Type I Malformation

Cited by 12 publications

References 18 publications

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document

Decompressive Surgery for Craniovertebral Foramen Magnum Stenosis with Medullary Compression in Paediatric Skeletal Dysplasia Syndromes

Use of Intraoperative Neuromonitoring in Surgical Treatment of Acute Presentation of Chiari I Malformation: A Case Report

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