Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I

Wu, Tao; Zhu, Zezhang; Jiang, Jian; Zheng, Xin; Sun, Xu; Qian, Bangping; Zhu, Feng; Qiu, Yong

doi:10.1007/s00586-011-2064-3

Cited by 40 publications

(31 citation statements)

References 30 publications

(43 reference statements)

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“…Similar to other studies, the majorities of the abnormalities in our series were Chiari 1 malformation or syringomyelia or combined. Previous studies have demonstrated that a large proportion of patients with Chiari 1 malformation or syringomyelia have no other clinical symptom except scoliosis [24,25]. Sexual dimorphism was one of the significant features of IS, and considered to be related to the etiopathogenesis of AIS.…”

Section: Discussionmentioning

confidence: 99%

Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis

Qiao

Zhu

et al. 2012

Eur Spine J

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Section: Discussionmentioning

confidence: 99%

Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis

Qiao

Zhu

et al. 2012

Eur Spine J

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“…While sex, age, duration of followup, tonsillar and syrinx characteristics, [21][22][23]32 and pB-C2 distance 17 have been demonstrated to be associated with syrinx resolution in some studies, 1 study considered multiple variables 30 and found none to be associated with radiological outcome. The results with regard to clinical outcomes have been similarly diverse, with variables like 4 and spinal cord diameter 9 established as being correlated with outcomes.…”

Section: Predictive Variables Identified In Previous CMI Studiesmentioning

confidence: 99%

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

Thakar

Sivaraju

Jacob

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEAlthough various predictors of postoperative outcome have been previously identified in patients with Chiari malformation Type I (CMI) with syringomyelia, there is no known algorithm for predicting a multifactorial outcome measure in this widely studied disorder. Using one of the largest preoperative variable arrays used so far in CMI research, the authors attempted to generate a formula for predicting postoperative outcome.METHODSData from the clinical records of 82 symptomatic adult patients with CMI and altered hindbrain CSF flow who were managed with foramen magnum decompression, C-1 laminectomy, and duraplasty over an 8-year period were collected and analyzed. Various preoperative clinical and radiological variables in the 57 patients who formed the study cohort were assessed in a bivariate analysis to determine their ability to predict clinical outcome (as measured on the Chicago Chiari Outcome Scale [CCOS]) and the resolution of syrinx at the last follow-up. The variables that were significant in the bivariate analysis were further analyzed in a multiple linear regression analysis. Different regression models were tested, and the model with the best prediction of CCOS was identified and internally validated in a subcohort of 25 patients.RESULTSThere was no correlation between CCOS score and syrinx resolution (p = 0.24) at a mean ± SD follow-up of 40.29 ± 10.36 months. Multiple linear regression analysis revealed that the presence of gait instability, obex position, and the M-line–fourth ventricle vertex (FVV) distance correlated with CCOS score, while the presence of motor deficits was associated with poor syrinx resolution (p ≤ 0.05). The algorithm generated from the regression model demonstrated good diagnostic accuracy (area under curve 0.81), with a score of more than 128 points demonstrating 100% specificity for clinical improvement (CCOS score of 11 or greater). The model had excellent reliability (κ = 0.85) and was validated with fair accuracy in the validation cohort (area under the curve 0.75).CONCLUSIONSThe presence of gait imbalance and motor deficits independently predict worse clinical and radiological outcomes, respectively, after decompressive surgery for CMI with altered hindbrain CSF flow. Caudal displacement of the obex and a shorter M-line–FVV distance correlated with good CCOS scores, indicating that patients with a greater degree of hindbrain pathology respond better to surgery. The proposed points-based algorithm has good predictive value for postoperative multifactorial outcome in these patients.

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“…One study by Wu and colleagues of 44 pediatric patients undergoing dural opening PFD for CM-I, syrinx, and scoliosis reported syrinx improvement in 82% of patients by 6 months postoperatively, and in 98% of patients over the course of follow-up. 48 Wetjen and colleagues studied 29 adult patients with CM-I and syrinx after dural opening PFD and found the median time from surgery to greater than 50% reduction in syrinx size to be 3.6 months with a mean of 6.5 months. 46 By 6 months, 86% of patients had demonstrated radiographic improvement, and all 29 patients demonstrated radiographic improvement during their follow-up.…”

Section: Discussionmentioning

confidence: 99%

Delayed resolution of syrinx after posterior fossa decompression without dural opening in children with Chiari malformation Type I

Kennedy¹,

Nelp²,

Kelly³

et al. 2015

PED

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OBJECT Chiari malformation Type I (CM-I) is associated with a syrinx in 25%–85% of patients. Although posterior fossa decompression (PFD) without dural opening is an accepted treatment option for children with symptomatic CM-I, many surgeons prefer to open the dura if a syrinx exists. The purpose of this study was to investigate the frequency and timing of syrinx resolution in children undergoing PFD without dural opening for CM-I. METHODS A retrospective review of 68 consecutive pediatric patients with CM-I and syringomyelia who underwent PFD without dural opening was conducted. Patient demographics, presenting symptoms and signs, radiographic findings, and intraoperative ultrasound and neuromonitoring findings were studied as well as the patients’ clinical and radiographic follow-up. RESULTS During the mean radiographic follow-up period of 32 months, 70% of the syringes improved. Syrinx improvement occurred at a mean of 31 months postoperatively. All patients experienced symptom improvement within the 1st year, despite only 26% of patients showing radiographic improvement during that period. Patients presenting with sensory symptoms or motor weakness had a higher likelihood of having radiographic syrinx improvement postoperatively. CONCLUSIONS In children with CM-I and a syrinx undergoing PFD without dural opening, syrinx resolution occurs in approximately 70% of patients. Radiographic improvement of the syrinx is delayed, but this does not correlate temporally with symptom improvement. Sensory symptoms or motor weakness on presentation are associated with syrinx resolution after surgery.

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Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I

Cited by 40 publications

References 30 publications

Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis

Indication for preoperative MRI of neural axis abnormalities in patients with presumed thoracolumbar/lumbar idiopathic scoliosis

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients

Delayed resolution of syrinx after posterior fossa decompression without dural opening in children with Chiari malformation Type I

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