The pediatric Chiari I malformation: a review

Tubbs, R. Shane; Lyerly, Michael; Loukas, Marios; Shoja, Mohammadali Mohajel; Oakes, W. Jerry

doi:10.1007/s00381-007-0428-0

Cited by 178 publications

(127 citation statements)

References 118 publications

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“…Herniations with a length of tonsilla cerebelli expanding from the level of the foramen magnum to the canalis vertebralis > 3 mm were considered to be CMI (22)(23)(24)(25).…”

Section: Measurements Of the Tonsillar Herniation The Posterior Heigmentioning

confidence: 99%

The Relationship of the Posterior Cranial Fossa, the Cerebrum, and Cerebellum Morphometry with Tonsiller Herniation

Taştemur¹,

Sabancıoğulları

Şalk

et al. 2016

Iran J Radiol

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Background: Tonsillar herniation is a condition that manifests as herniation of the brain parts, originating from the hindbrain and progressing through the foramen magnum into the cervical vertebral canal. Although the etiology of tonsillar herniation is unclear, it has been suggested that it may be congenital or acquired. In particular, there is speculation that primary mesodermal insufficiency may affect the size of the posterior cranial fossa.

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“…Herniations with a length of tonsilla cerebelli expanding from the level of the foramen magnum to the canalis vertebralis > 3 mm were considered to be CMI (22)(23)(24)(25).…”

Section: Measurements Of the Tonsillar Herniation The Posterior Heigmentioning

confidence: 99%

The Relationship of the Posterior Cranial Fossa, the Cerebrum, and Cerebellum Morphometry with Tonsiller Herniation

Taştemur¹,

Sabancıoğulları

Şalk

et al. 2016

Iran J Radiol

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“…less often include occipitocervical instability and acute postoperative hydrocephalus. 5,9,24 As a result of these complications, many surgeons have moved toward less invasive surgical treatments such as "extradural decompression" alone, which involves bony decompression plus or minus thinning or splitting of the dura without actually entering the intradural space. 6,7,17,20,29 The theoretical advantages associated with this less invasive technique include reduced operative times, lower rates of CSF leakage and postoperative complications, and reduced postoperative hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…19 Surgical decompression of CM-I is often recommended in symptomatic patients with CSF obstruction, as it has been shown to improve the clinical course of these patients. 21,24 While multiple surgical treatment strategies have been described in the literature, the most common procedure currently performed is posterior fossa decompression, which consists of a suboccipital craniectomy and C-1 laminectomy, with duraplasty. 12 Multiple previous studies have reported a range of complications associated with surgical management of CM-I (range 3%-40%).…”

Section: ©Aans 2013mentioning

confidence: 99%

Effect of symptomatic pseudomeningocele on improvement in pain, disability, and quality of life following suboccipital decompression for adult Chiari malformation Type I

Parker¹,

Godil²,

Zuckerman³

et al. 2013

JNS

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Object. Suboccipital decompression is a common procedure for patients with Chiari malformation Type I (CM-I). Published studies have reported complication rates ranging from 3% to 40%, with pseudomeningocele being one of the most common complications. To date, there are no studies assessing the effect of this complication on long-term outcome. Therefore, the authors set out to assess the effect of symptomatic pseudomeningocele on patient outcomes following suboccipital decompression for CM-I.Methods. The study comprised 50 adult patients with CM-I who underwent suboccipital craniectomy and C-1 laminectomy with or without duraplasty. Clinical presentation, radiological studies, operative variables, and complications were assessed for each case. Baseline and 1-year postoperative patient-reported outcomes were assessed to determine improvement in pain, disability, and quality of life. The extent of improvement was compared for patients with and without development of a postoperative symptomatic pseudomeningocele.Results. A symptomatic pseudomeningocele developed postoperatively in 9 patients (18%). There was no difference with regard to clinical, radiological, or operative variables for patients with or without a postoperative pseudomeningocele. Patients without a pseudomeningocele had significant improvement in all 9 patient-reported outcome measures assessed. On the other hand, patients with pseudomeningocele only had significant improvement in headache (as measured on the Numeric Rating Scale) and headache-related disability (as measured on the Headache Disability Index) but no improvement in quality of life. Twenty-nine (71%) of 41 patients without a pseudomeningocele reported improvement in health status postoperatively compared with only 3 (33%) of 9 patients with a postoperative pseudomeningocele (p = 0.05).Conclusions. Surgical management of CM-I in adults provides significant and sustained improvement in pain, disability, general health, and quality of life. Development of a postoperative symptomatic pseudomeningocele has lingering effects at 1 year, and it significantly diminishes the overall benefit of suboccipital decompression for CMrelated symptoms. Further research is needed to accurately predict which patients may benefit from decompression alone without duraplasty. (http://thejns.org/doi/abs/10.3171/2013.8.JNS122106) key worDS • symptomatic pseudomeningocele • Chiari malformation • suboccipital decompression • quality of life • pain

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“…These include visual disturbances, dysphonia, dysphagia, sleep apnea, clumsiness and incoordination, and sensory disturbances. 128,129 CM may also lead to the development of syringomyelia, which, in turn, may lead to other symptoms including motor and sensory difficulties, pain, and scoliosis. [130][131][132][133][134] Surgical case series tend to overestimate the frequency of syringomyelia in patients with CM.…”

Section: Chiari and Syringomyeliamentioning

confidence: 99%

Incidental Findings on Brain and Spine Imaging in Children

Maher¹,

Piatt²,

Ragheb³

et al. 2015

Pediatrics

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In recent years, the utilization of diagnostic imaging of the brain and spine in children has increased dramatically, leading to a corresponding increase in the detection of incidental findings of the central nervous system. Patients with unexpected findings on imaging are often referred for subspecialty evaluation. Even with rational use of diagnostic imaging and subspecialty consultation, the diagnostic process will always generate unexpected findings that must be explained and managed. Familiarity with the most common findings that are discovered incidentally on diagnostic imaging of the brain and spine will assist the pediatrician in providing counseling to families and in making recommendations in conjunction with a neurosurgeon, when needed, regarding additional treatments and prognosis.

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The pediatric Chiari I malformation: a review

Cited by 178 publications

References 118 publications

The Relationship of the Posterior Cranial Fossa, the Cerebrum, and Cerebellum Morphometry with Tonsiller Herniation

The Relationship of the Posterior Cranial Fossa, the Cerebrum, and Cerebellum Morphometry with Tonsiller Herniation

Effect of symptomatic pseudomeningocele on improvement in pain, disability, and quality of life following suboccipital decompression for adult Chiari malformation Type I

Incidental Findings on Brain and Spine Imaging in Children

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