Surgical experience in 130 pediatric patients with Chiari I malformations

Tubbs, R. Shane; McGirt, Matthew J.; Oakes, W. Jerry

doi:10.3171/jns.2003.99.2.0291

Cited by 288 publications

(197 citation statements)

References 59 publications

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“…Re- ported rates of scoliosis vary in the literature. In a series of 130 patients, Tubbs et al 13 demonstrated that 18% of those with CM-I presented with concurrent scoliosis. It is not clear why our series shows a lower percentage of patients with scoliosis, although it may be due to regional differences or our referral pattern.…”

Section: Discussionmentioning

confidence: 99%

Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Attenello¹,

McGirt²,

Atiba³

et al. 2008

PED

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Object Chiari malformation Type I (CM-I) is often associated with scoliosis. It remains unclear which subgroups of patients are most likely to experience progression of spinal deformity after cervicomedullary decompression. The authors' goal was to determine the time frame of curvature progression and assess which patient subgroups are at greatest risk for progression of spinal deformity after surgery. Methods The authors retrospectively reviewed the records of all pediatric patients with significant scoliosis in whom suboccipital decompression was performed to treat for CM-I during a 10-year period at a single academic institution. Clinical, radiological, and operative variables were assessed as independent factors for failure (worsening of scoliosis) by using a univariate regression analysis. Results Twenty-one children (mean age 9 ± 3 years; 4 male) underwent hindbrain decompression for CM-I–associated scoliosis and were followed for a mean of 39 months. All patients harbored a syrinx. Eight patients (38%) experienced improvement in scoliosis curvature, whereas 10 (48%) suffered a progression. Thoracolumbar junction scoliosis (p = 0.04) and failure of the syrinx to improve (p = 0.05) were associated with 5- and 4-fold respective increases in the likelihood of deformity progression. Each increasing degree of preoperative Cobb angle was associated with an 11% increase in the likelihood of scoliotic curve progression (p < 0.05). Conclusions Over one third of patients with CM-I–associated scoliosis will improve after cervicomedullary decompression alone. Cervicomedullary decompression is a good first-line option, particularly in children with concordant posterior fossa symptoms. Patients presenting with more severe scoliosis (increasing Cobb angle) or scoliosis that crosses the thoracolumbar junction may benefit from earlier orthopedic involvement and should be monitored regularly for curvature progression after cervicomedullary decompression. In cases in which there is a failure of the syrinx to show improvement after suboccipital decompression, the patients are also more likely to develop curvature progression.

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Section: Discussionmentioning

confidence: 99%

Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Attenello¹,

McGirt²,

Atiba³

et al. 2008

PED

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“…Tubbs et al [11][12][13] reviewed 130 symptomatic pediatric Chiari I malformation patients and 22 of them were Chiari 1.5 malformation patients. Clinical manifestations and symptomatic outcomes were similar between the two groups in terms of degree of tonsillar herniation (Chiari I malformation vs. Chiari 1.5 malformation : 7 mm vs. 12.7 mm), the angulation of the odontoid process (98.0˚vs.…”

Section: Discussionmentioning

confidence: 99%

“…This theory indicates an alteration in cerebrospinal fluid (CSF) circulation and relative obstruction of CSF flow at the foramen magnum 9) . Presumably, an intermittent vector of force then develops with each Valsalva maneuver, which can lead to the progressive downward movement of developing tissue through the foramen magnum 12) . In the present case, the patient was incidentally found to have tonsillar herniation and mild ventriculomegaly.…”

Section: Discussionmentioning

confidence: 99%

Chiari 1.5 Malformation : An Advanced Form of Chiari I Malformation

Kim

Wang

Cho

2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 48 : [375][376][377][378][379] 2010 The Chiari 1.5 malformation is defined as a tonsillar herniation within a Chiari I malformation with additional caudal descent of the brainstem through the foramen magnum. We describe a patient with Chiari I malformation who evolved to Chiari 1.5 malformation during longitudinal follow-up. A 15-year-old girl presented with neck pain during exercise for two years. She had been diagnosed with Chiari I malformation with mild hydrocephalus after minor cervical trauma at the age of six years. At that time, she was asymptomatic. After she complained of aggravated neck pain, neuroimaging (nine years after first imaging) revealed caudal descent of the brainstem and syringomyelia in addition to progression of tonsillar herniation. Posterior fossa decompressive surgery resulted in complete resolution of neck pain. Based on neuroimaging and operative findings, she was diagnosed as Chiari 1.5 malformation. Neuroimaging performed seven months after surgery showed an increased anteriorposterior diameter of the medulla oblongata and markedly decreased syringomyelia. This case demonstrates progressive developmental process of the Chiari 1.5 malformation as an advanced form of the Chiari I malformation.KEY WORDS : Chiari 1.5 malformation˙ Asymptomatic hydrocephalus˙ Syringomyelia.

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“…Neurologic deficit prior to the onset of treatment indicates an increased possibility of additional injury. This situation has been reported to be suggestive of brain stem and intraspinal anomalies [12][13][14][15][16][17][18]. In these patients, who have chronic ischemia and hypoxia of the spinal cord due to the spinal deformities, ''sick spinal cord'' which together with the abnormalities of the spinal cord or the canal, distraction or compression of the spinal cord following corrective maneuvers for the curve may lead to Fig.…”

Section: Clinical Factorsmentioning

confidence: 99%

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

et al. 2013

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Purpose To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery. Methods A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10-48 years). There were 52 adolescent patients (with an age \18 years) and 24 adult patients (with an age C18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis. Results No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P \ 0.05): location of apex at main curve (X 3 ), Cobb angle at the main curve at the coronal plane (X 4 ), scoliosis associated with thoracic hyperkyphosis (X 5 ), level of vertebral column resected (X 6 ), number of segmental vessels ligated (X 7 ), preexisting neurologic dysfunction (X 8 ), and associated with intraspinal and brain stem anomalies (X 9 ). The multi-factor unconditional logistic regression analysis revealed that X 8 (OR = 49.322), X 9 (OR = 18.423), X 5 (OR = 11.883), and X 6 (OR = 8.769) were independent and positively correlated with the neurologic deficit. Conclusions Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.

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Surgical experience in 130 pediatric patients with Chiari I malformations

Abstract: The authors believe this to be the largest reported series of pediatric patients who have undergone posterior fossa decompression for Chiari I malformations.

Cited by 288 publications

References 59 publications

Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Chiari 1.5 Malformation : An Advanced Form of Chiari I Malformation

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

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