Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Aska Arnautovic George Washington University School of Medicine, Washington, DC;

Search for other papers by Aska Arnautovic in
jns
Google Scholar
PubMed
Close
 BSc
,
Bruno Splavski Department of Neurosurgery, Osijek University School of Medicine, Osijek, Croatia;

Search for other papers by Bruno Splavski in
jns
Google Scholar
PubMed
Close
 MD, PhD
,
Frederick A. Boop Semmes-Murphey Clinic; and
Department of Neurosurgery, University of Tennessee, Memphis, Tennessee

Search for other papers by Frederick A. Boop in
jns
Google Scholar
PubMed
Close
 MD
, and
Kenan I. Arnautovic Semmes-Murphey Clinic; and
Department of Neurosurgery, University of Tennessee, Memphis, Tennessee

Search for other papers by Kenan I. Arnautovic in
jns
Google Scholar
PubMed
Close
 MD, PhD
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $536.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $536.00
USD  $636.00
Print or Print + Online Sign in

OBJECT

Chiari malformation Type I (CM-I) is a hindbrain disorder associated with elongation of the cerebellar tonsils, which descend below the foramen magnum into the spinal canal. It occurs in children and adults. Clinical symptoms mainly develop from alterations in CSF flow at the foramen magnum and the common subsequent development of syringomyelia.

METHODS

The authors reviewed English-language reports of pediatric, adult, and combined (adult and pediatric) surgical series of patients with CM-I published from 1965 through August 31, 2013, to investigate the following: 1) geographical distribution of reports; 2) demographics of patients; 3) follow-up lengths; 4) study durations; 5) spectrum and frequency of surgical techniques; 6) outcomes for neurological status, syrinx, and headache; 7) frequency and scope of complications; 8) mortality rates; and 9) differences between pediatric and adult populations. Research and inclusion criteria were defined, and all series that contained at least 4 cases and all publications with sufficient data for analysis were included.

RESULTS

The authors identified 145 operative series of patients with CM-I, primarily from the United States and Europe, and divided patient ages into 1 of 3 categories: adult (> 18 years of age; 27% of the cases), pediatric (≤ 18 years of age; 30%), or unknown (43%). Most series (76%) were published in the previous 21 years. The median number of patients in the series was 31. The mean duration of the studies was 10 years, and the mean follow-up time was 43 months. The peak ages of presentation in the pediatric studies were 8 years, followed by 9 years, and in the adult series, 41 years, followed by 46 years. The incidence of syringomyelia was 65%. Most of the studies (99%) reported the use of posterior fossa/foramen magnum decompression. In 92%, the dura was opened, and in 65% of these cases, the arachnoid was opened and dissected; tonsillar resection was performed in 27% of these patients. Postoperatively, syringomyelia improved or resolved in 78% of the patients. Most series (80%) reported postoperative neurological outcomes as follows: 75% improved, 17% showed no change, and 9% experienced worsening. Postoperative headaches improved or resolved in 81% of the patients, with a statistical difference in favor of the pediatric series. Postoperative complications were reported for 41% of the series, most commonly with CSF leak, pseudomeningocele, aseptic meningitis, wound infection, meningitis, and neurological deficit, with a mean complication rate of 4.5%. Complications were reported for 37% of pediatric, 20% of adult, and 43% of combined series. Mortality was reported for 11% of the series. No difference in mortality rates was seen between the pediatric and adult series.

CONCLUSIONS

Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications. Furthermore, surgeons may benefit from comparing published data with their own. In the future, operative CM-I reports should provide all details of each case for the purpose of comparison.

ABBREVIATIONS

BMI = body mass index; CM-I = Chiari malformation Type I; IQR = interquartile range.
  • Collapse
  • Expand
  • 1

    Aitken LA, , Lindan CE, , Sidney S, , Gupta N, , Barkovich AJ, & Sorel M, et al.: Chiari type I malformation in a pediatric population. Pediatr Neurol 40:449454, 2009

  • 2

    Albert GW, , Menezes AH, , Hansen DR, , Greenlee JD, & Weinstein SL: Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome. J Neurosurg Pediatr 5:554561, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Alden TD, , Ojemann JG, & Park TS: Surgical treatment of Chiari I malformation: indications and approaches. Neurosurg Focus 11:1 E2, 2001

  • 4

    Alfieri A, & Pinna G: Long-term results after posterior fossa decompression in syringomyelia with adult Chiari Type I malformation. J Neurosurg Spine 17:381387, 2012

  • 5

    Aliaga L, , Hekman KE, , Yassari R, , Straus D, , Luther G, & Chen J, et al.: A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery 70:656665, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Alzate JC, , Kothbauer KF, , Jallo GI, & Epstein FJ: Treatment of Chiari I malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus 11:1 E3, 2001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Appleby A, , Foster JB, , Hankinson J, & Hudgson P: The diagnosis and management of the Chiari anomalies in adult life. Brain 91:131140, 1968

  • 8

    Archer CR, , Horenstein S, & Sundaram M: The Arnold-Chiari malformation presenting in adult life. A report of thirteen cases and a review of the literature. J Chronic Dis 30:369382, 1977

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Armonda RA, , Citrin CM, , Foley KT, & Ellenbogen RG: Quantitative cine-mode magnetic resonance imaging of Chiari I malformations: an analysis of cerebrospinal fluid dynamics. Neurosurgery 35:214224, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Arnautovic KI, , Muzevic D, , Splavski B, & Boop FA: Association of increased body mass index with Chiari malformation Type I and syrinx formation in adults. J Neurosurg 119:10581067, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Arora P, , Behari S, , Banerji D, , Chhabra DK, & Jain VK: Factors influencing the outcome in symptomatic Chiari I malformation. Neurol India 52:470474, 2004

  • 12

    Arruda JA, , Costa CM, & Tella OI Jr: Results of the treatment of syringomyelia associated with Chiari malformation: analysis of 60 cases. Arq Neuropsiquiatr 62:2A 237244, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Asgari S, , Engelhorn T, , Bschor M, , Sandalcioglu IE, & Stolke D: Surgical prognosis in hindbrain related syringomyelia. Acta Neurol Scand 107:1221, 2003

  • 14

    Attal N, , Parker F, , Tadié M, , Aghakani N, & Bouhassira D: Effects of surgery on the sensory deficits of syringomyelia and predictors of outcome: a long term prospective study. J Neurol Neurosurg Psychiatry 75:10251030, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Attenello FJ, , McGirt MJ, , Garcés-Ambrossi GL, , Chaichana KL, , Carson B, & Jallo GI: Suboccipital decompression for Chiari I malformation: outcome comparison of duraplasty with expanded polytetrafluoroethylene dural substitute versus pericranial autograft. Childs Nerv Syst 25:183190, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Badie B, , Mendoza D, & Batzdorf U: Posterior fossa volume and response to suboccipital decompression in patients with Chiari I malformation. Neurosurgery 37:214218, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Banerji NK, & Millar JHD: Chiari malformation presenting in adult life. Its relationship to syringomyelia. Brain 97:157168, 1974

  • 18

    Batzdorf U: Chiari I malformation with syringomyelia. Evaluation of surgical therapy by magnetic resonance imaging. J Neurosurg 68:726730, 1988

  • 19

    Batzdorf U, , McArthur DL, & Bentson JR: Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients. J Neurosurg 118:232242, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Bejjani GK: Definition of the adult Chiari malformation: a brief historical overview. Neurosurg Focus 11:1 E1, 2001

  • 21

    Bidziński J: Late results of the surgical treatment of syringomyelia. Acta Neurochir Suppl (Wien) 43:2931, 1988

  • 22

    Bindal AK, , Dunsker SB, & Tew JM Jr: Chiari I malformation: classification and management. Neurosurgery 37:10691074, 1995

  • 23

    Blagodatsky MD, , Larionov SN, , Alexandrov YA, & Velm AI: Surgical treatment of Chiari I malformation with or without syringomyelia. Acta Neurochir (Wien) 141:963968, 1999

  • 24

    Bollo RJ, , Riva-Cambrin J, , Brockmeyer MM, & Brockmeyer DL: Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion. J Neurosurg Pediatr 10:134141, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Brockmeyer D, , Gollogly S, & Smith JT: Scoliosis associated with Chiari I malformation: the effect of suboccipital decompression on scoliosis curve progression: a preliminary study. Spine 28:Phila Pa 1976 25052509, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Caetano de Barros M, , Farias W, , Ataíde L, & Lins S: Basilar impression and Arnold-Chiari malformation. A study of 66 cases. J Neurol Neurosurg Psychiatry 31:596605, 1968

  • 27

    Cahan LD, & Bentson JR: Considerations in the diagnosis and treatment of syringomyelia and the Chiari malformation. J Neurosurg 57:2431, 1982

  • 28

    Caldarelli M, , Novegno F, , Vassimi L, , Romani R, , Tamburrini G, & Di Rocco C: The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation Type I: experience with a pediatric series. J Neurosurg 106:3 Suppl 187195, 2007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Chauvet D, , Carpentier A, & George B: Dura splitting decompression in Chiari type 1 malformation: clinical experience and radiological findings. Neurosurg Rev 32:465470, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Chen JA, , Coutin-Churchman PE, , Nuwer MR, & Lazareff JA: Suboccipital craniotomy for Chiari I results in evoked potential conduction changes. Surg Neurol Int 3:165, 2012

  • 31

    Chou YC, , Sarkar R, , Osuagwu FC, & Lazareff JA: Suboccipital craniotomy in the surgical treatment of Chiari I malformation. Childs Nerv Syst 25:11111114, 2009

  • 32

    Cristante L, , Westphal M, & Herrmann HD: Cranio-cervical decompression for Chiari I malformation. A retrospective evaluation of functional outcome with particular attention to the motor deficits. Acta Neurochir (Wien) 130:94100, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Dauser RC, , DiPietro MA, & Venes JL: Symptomatic Chiari I malformation in childhood: a report of 7 cases. Pediatr Neurosci 14:184190, 1988

  • 34

    Depreitere B, , Van Calenbergh F, , van Loon J, , Goffin J, & Plets C: Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients. Clin Neurol Neurosurg 102:9196, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Di X: Endoscopic suboccipital decompression on pediatric Chiari type I. Minim Invasive Neurosurg 52:119125, 2009

  • 36

    Di Lorenzo N, , Palma L, , Palatinsky E, & Fortuna A: “Conservative” cranio-cervical decompression in the treatment of syringomyelia-Chiari I complex. A prospective study of 20 adult cases. Spine (Phila Pa 1976) 20:24792483, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Dones J, , De Jesús O, , Colen CB, , Toledo MM, & Delgado M: Clinical outcomes in patients with Chiari I malformation: a review of 27 cases. Surg Neurol 60:142148, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Dubey A, , Sung WS, , Shaya M, , Patwardhan R, , Willis B, & Smith D, et al.: Complications of posterior cranial fossa surgery—an institutional experience of 500 patients. Surg Neurol 72:369375, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    du Boulay G, , Shah SH, , Currie JC, & Logue V: The mechanism of hydromyelia in Chiari type 1 malformations. Br J Radiol 47:579587, 1974

  • 40

    Duddy MJ, & Williams B: Hindbrain migration after decompression for hindbrain hernia: a quantitative assessment using MRI. Br J Neurosurg 5:141152, 1991

  • 41

    Dure LS, , Percy AK, , Cheek WR, & Laurent JP: Chiari type I malformation in children. J Pediatr 115:573576, 1989

  • 42

    Durham SR, & Fjeld-Olenec K: Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr 2:4249, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Dyste GN, , Menezes AH, & VanGilder JC: Symptomatic Chiari malformations. An analysis of presentation, management, and long-term outcome. J Neurosurg 71:159168, 1989

  • 44

    Eisenstat DD, , Bernstein M, , Fleming JF, , Vanderlinden RG, & Schutz H: Chiari malformation in adults: a review of 40 cases. Can J Neurol Sci 13:221228, 1986

  • 45

    El-Ghandour NMF: Long-term outcome of surgical management of adult Chiari I malformation. Neurosurg Rev 35:537547, 2012

  • 46

    Ellenbogen RG, , Armonda RA, , Shaw DW, & Winn HR: Toward a rational treatment of Chiari I malformation and syringomyelia. Neurosurg Focus 8:3 E6, 2000

  • 47

    Emery E, , Redondo A, & Rey A: Syringomyelia and Arnold Chiari in scoliosis initially classified as idiopathic: experience with 25 patients. Eur Spine J 6:158162, 1997

  • 48

    Erdogan E, , Cansever T, , Secer HI, , Temiz C, , Sirin S, & Kabatas S, et al.: The evaluation of surgical treatment options in the Chiari malformation Type I. Turk Neurosurg 20:303313, 2010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Ergün R, , Akdemir G, , Gezici AR, , Tezel K, , Beskonakli E, & Ergüngör F, et al.: Surgical management of syringomyelia-Chiari complex. Eur Spine J 9:553557, 2000

  • 50

    Eule JM, , Erickson MA, , O'Brien MF, & Handler M: Chiari I malformation associated with syringomyelia and scoliosis: a twenty-year review of surgical and nonsurgical treatment in a pediatric population. Spine (Phila Pa 1976) 27:14511455, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51

    Feldstein NA, & Choudhri TF: Management of Chiari I malformations with holocord syringohydromyelia. Pediatr Neurosurg 31:143149, 1999

  • 52

    Fischer EG: Posterior fossa decompression for Chiari I deformity, including resection of the cerebellar tonsils. Childs Nerv Syst 11:625629, 1995

  • 53

    Flynn JM, , Sodha S, , Lou JE, , Adams SB Jr, , Whitfield B, & Ecker ML, et al.: Predictors of progression of scoliosis after decompression of an Arnold Chiari I malformation. Spine (Phila Pa 1976) 29:286292, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54

    Foreman P, , Safavi-Abbasi S, , Talley MC, , Boeckman L, & Mapstone TB: Perioperative outcomes and complications associated with allogeneic duraplasty for the management of Chiari malformations Type I in 48 pediatric patients. J Neurosurg Pediatr 10:142149, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55

    Fujii K, , Natori Y, , Nakagaki H, & Fukui M: Management of syringomyelia associated with Chiari malformation: comparative study of syrinx size and symptoms by magnetic resonance imaging. Surg Neurol 36:281285, 1991

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56

    Galarza M, , Sood S, & Ham S: Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Childs Nerv Syst 23:691696, 2007

  • 57

    Gambardella G, , Caruso G, , Caffo M, , Germanò A, , La Rosa G, & Tomasello F: Transverse microincisions of the outer layer of the dura mater combined with foramen magnum decompression as treatment for syringomyelia with Chiari I malformation. Acta Neurochir (Wien) 140:134139, 1998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58

    Garcìa-Uria J, , Leunda G, , Carrillo R, & Bravo G: Syringomyelia: long-term results after posterior fossa decompression. J Neurosurg 54:380383, 1981

  • 59

    Gardner WJ: Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry 28:247259, 1965

  • 60

    Genitori L, , Peretta P, , Nurisso C, , Macinante L, & Mussa F: Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases. Childs Nerv Syst 16:707718, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 61

    Ghanem IB, , Londono C, , Delalande O, & Dubousset JF: Chiari I malformation associated with syringomyelia and scoliosis. Spine (Phila Pa 1976) 22:13131318, 1997

  • 62

    Godil SS, , Parker SL, , Zuckerman SL, , Mendenhall SK, & McGirt MJ: Accurately measuring outcomes after surgery for adult Chiari I malformation: determining the most valid and responsive instruments. Neurosurgery 72:820827, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63

    Goel A, , Bhatjiwale M, & Desai K: Basilar invagination: a study based on 190 surgically treated patients. J Neurosurg 88:962968, 1998

  • 64

    Greenberg MS: Handbook of Neurosurgery ed 7 New York, Thieme, 2010. 234

  • 65

    Greenlee JD, , Donovan KA, , Hasan DM, & Menezes AH: Chiari I malformation in the very young child: the spectrum of presentations and experience in 31 children under age 6 years. Pediatrics 110:12121219, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66

    Guo F, , Wang M, , Long J, , Wang H, , Sun H, & Yang B, et al.: Surgical management of Chiari malformation: analysis of 128 cases. Pediatr Neurosurg 43:375381, 2007

  • 67

    Guyotat J, , Bret P, , Jouanneau E, , Ricci AC, & Lapras C: Syringomyelia associated with type I Chiari malformation. A 21-year retrospective study on 75 cases treated by foramen magnum decompression with a special emphasis on the value of tonsils resection. Acta Neurochir (Wien) 140:745754, 1998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68

    Hankinson T, , Tubbs RS, & Wellons JC: Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation. Childs Nerv Syst 27:3540, 2011

  • 69

    Haroun RI, , Guarnieri M, , Meadow JJ, , Kraut M, & Carson BS: Current opinions for the treatment of syringomyelia and chiari malformations: survey of the Pediatric Section of the American Association of Neurological Surgeons. Pediatr Neurosurg 33:311317, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 70

    Hayhurst C, , Richards O, , Zaki H, , Findlay G, & Pigott TJ: Hindbrain decompression for Chiari-syringomyelia complex: an outcome analysis comparing surgical techniques. Br J Neurosurg 22:8691, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 71

    Heiss JD, , Patronas N, , DeVroom HL, , Shawker T, , Ennis R, & Kammerer W, et al.: Elucidating the pathophysiology of syringomyelia. J Neurosurg 91:553562, 1999

  • 72

    Heiss JD, , Snyder K, , Peterson MM, , Patronas NJ, , Butman JA, & Smith RK, et al.: Pathophysiology of primary spinal syringomyelia. J Neurosurg Spine 17:367380, 2012

  • 73

    Heiss JD, , Suffredini G, , Bakhtian KD, , Sarntinoranont M, & Oldfield EH: Normalization of hindbrain morphology after decompression of Chiari malformation Type I. J Neurosurg 117:942946, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 74

    Heller JB, , Lazareff J, , Gabbay JS, , Lam S, , Kawamoto HK, & Bradley JP: Posterior cranial fossa box expansion leads to resolution of symptomatic cerebellar ptosis following Chiari I malformation repair. J Craniofac Surg 18:274280, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 75

    Hida K, , Iwasaki Y, , Koyanagi I, , Sawamura Y, & Abe H: Surgical indication and results of foramen magnum decompression versus syringosubarachnoid shunting for syringomyelia associated with Chiari I malformation. Neurosurgery 37:673679, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 76

    Hoffman CE, & Souweidane MM: Cerebrospinal fluid-related complications with autologous duraplasty and arachnoid sparing in type I Chiari malformation. Neurosurgery 62:3 Suppl 1 156161, 2008

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 77

    Hoffman HJ, , Neill J, , Crone KR, , Hendrick EB, & Humphreys RP: Hydrosyringomyelia and its management in childhood. Neurosurgery 21:347351, 1987

  • 78

    Holly LT, & Batzdorf U: Management of cerebellar ptosis following craniovertebral decompression for Chiari I malformation. J Neurosurg 94:2126, 2001

  • 79

    Isu T, , Sasaki H, , Takamura H, & Kobayashi N: Foramen magnum decompression with removal of the outer layer of the dura as treatment for syringomyelia occurring with Chiari I malformation. Neurosurgery 33:845850, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 80

    James HE, & Brant A: Treatment of the Chiari malformation with bone decompression without durotomy in children and young adults. Childs Nerv Syst 18:202206, 2002

  • 81

    Jones RF, , Ayer JG, & Stening WA: Hydromyelia and Chiari malformation in children and adolescents. J Clin Neurosci 3:3445, 1996

  • 82

    Klekamp J: Surgical treatment of Chiari I malformation—analysis of intraoperative findings, complications, and outcome for 371 foramen magnum decompressions. Neurosurgery 71:365380, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 83

    Klekamp J, , Batzdorf U, , Samii M, & Bothe HW: The surgical treatment of Chiari I malformation. Acta Neurochir (Wien) 138:788801, 1996

  • 84

    Koç K, , Anik Y, , Anik I, , Cabuk B, & Ceylan S: Chiari 1 malformation with syringomyelia: correlation of phase-contrast cine MR imaging and outcome. Turk Neurosurg 17:183192, 2007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 85

    Kotil K, , Ton T, , Tari R, & Savas Y: Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study. Cerebrospinal Fluid Res 6:1, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 86

    Krieger MD, , McComb JG, & Levy ML: Toward a simpler surgical management of Chiari I malformation in a pediatric population. Pediatr Neurosurg 30:113121, 1999

  • 87

    Kunert P, , Janowski M, , Zakrzewska A, & Marchel A: Comparision of results between two different techniques of cranio-cervical decompression in patients with Chiari I malformation. Neurol Neurochir Pol 43:337345, 2009

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 88

    Lam FC, & Kasper E: Augmented autologuos pericranium duraplasty in 100 posterior fossa surgeries—a retrospective case series. Neurosurgery 71:2 Suppl Operative ons302ons307, 2012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 89

    Lazareff JA, , Galarza M, , Gravori T, & Spinks TJ: Tonsillectomy without craniectomy for the management of infantile Chiari I malformation. J Neurosurg 97:10181022, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 90

    Levy WJ, , Mason L, & Hahn JF: Chiari malformation presenting in adults: a surgical experience in 127 cases. Neurosurgery 12:377390, 1983

  • 91

    Liebenberg WA, , Georges H, , Demetriades AK, & Hardwidge C: Does posterior fossa decompression improve oculomotor and vestibulo-ocular manifestations in Chiari 1 malformation?. Acta Neurochir (Wien) 147:12391240, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 92

    Limonadi FM, & Selden NR: Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. J Neurosurg 101:2 Suppl 184188, 2004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 93

    Litvack ZN, , Lindsay RA, & Selden NR: Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization. Neurosurgery 72:922929, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 94

    Logue V, & Edwards MR: Syringomyelia and its surgical treatment—an analysis of 75 patients. J Neurol Neurosurg Psychiatry 44:273284, 1981

  • 95

    Maroun FB, , Jacob JC, & Mangan M: The Chiari malformation in adults. Can J Neurol Sci 2:115120, 1975

  • 96

    Matsumoto T, & Symon L: Surgical management of syringomyelia—current results. Surg Neurol 32:258265, 1989

  • 97

    McGirt MJ, , Attenello FJ, , Datoo G, , Gathinji M, , Atiba A, & Weingart JD, et al.: Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with Chiari malformation Type I. J Neurosurg Pediatr 2:5257, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 98

    Meadows J, , Guarnieri M, , Miller K, , Haroun R, , Kraut M, & Carson BS, et al.: Type I Chiari malformation: a review of the literature. Neurosurg Q 11:220229, 2001

  • 99

    Meadows J, , Kraut M, , Guarnieri M, , Haroun RI, & Carson BS: Asymptomatic Chiari Type I malformations identified on magnetic resonance imaging. J Neurosurg 92:920926, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 100

    Menezes AH: Chiari I malformations and hydromyelia—complications. Pediatr Neurosurg 17:146154, 1991. 1992

  • 101

    Milhorat TH, , Johnson WD, , Miller JI, , Bergland RM, & Hollenberg-Sher J: Surgical treatment of syringomyelia based on magnetic resonance imaging criteria. Neurosurgery 31:231245, 1992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 102

    Mohr PD, , Strang FA, , Sambrook MA, & Boddie HG: The clinical and surgical feature in 40 patients with primary cerebellar ectopia (adult Chiari malformation). Q J Med 46:8596, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 103

    Morgan D, & Williams B: Syringobulbia: a surgical appraisal. J Neurol Neurosurg Psychiatry 55:11321141, 1992

  • 104

    Mottolese C, , Szathmari A, , Simon E, , Rousselle C, , Ricci-Franchi AC, & Hermier M: Treatment of Chiari type I malformation in children: the experience of Lyon. Neurol Sci 32:Suppl 3 S325S330, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 105

    Mueller D, & Oro JJ: Prospective analysis of self-perceived quality of life before and after posterior fossa decompression in 112 patients with Chiari malformation with or without syringomyelia. Neurosurg Focus 18:2 ECP2, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 106

    Munshi I, , Frim D, , Stine-Reyes R, , Weir BK, , Hekmatpanah J, & Brown F: Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia. Neurosurgery 46:13841390, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 107

    Mutchnick IS, , Janjua RM, , Moeller K, & Moriarty TM: Decompression of Chiari malformation with and without duraplasty: morbidity versus recurrence. J Neurosurg Pediatr 5:474478, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 108

    Nagib MG: An approach to symptomatic children (ages 4–14 years) with Chiari type I malformation. Pediatr Neurosurg 21:3135, 1994

  • 109

    Navarro R, , Olavarria G, , Seshadri R, , Gonzales-Portillo G, , McLone DG, & Tomita T: Surgical results of posterior fossa decompression for patients with Chiari I malformation. Childs Nerv Syst 20:349356, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 110

    Nohria V, & Oakes WJ: Chiari I malformation: a review of 43 patients. Pediatr Neurosurg 16:222227, 1990. 1991

  • 111

    Noudel R, , Gomis P, , Sotoares G, , Bazin A, , Pierot L, & Pruvo JP, et al.: Posterior fossa volume increase after surgery for Chiari malformation Type I: a quantitative assessment using magnetic resonance imaging and correlations with the treatment response. J Neurosurg 115:647658, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 112

    Oldfield EH, , Muraszko K, , Shawker TH, & Patronas NJ: Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 80:315, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 113

    Ono A, , Ueyama K, , Okada A, , Echigoya N, , Yokoyama T, & Harata S: Adult scoliosis in syringomyelia associated with Chiari I malformation. Spine (Phila Pa 1976) 27:E23E28, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 114

    Padovani R, , Cavallo M, & Gaist G: Surgical treatment of syringomyelia: favorable results with syringosubarachnoid shunting. Surg Neurol 32:173180, 1989

  • 115

    Park JK, , Gleason PL, , Madsen JR, , Goumnerova LC, & Scott RM: Presentation and management of Chiari I malformation in children. Pediatr Neurosurg 26:190196, 1997

  • 116

    Parker SR, , Harris P, , Cummings TJ, , George T, , Fuchs H, & Grant G: Complications following decompression of Chiari malformation Type I in children: dural graft or sealant?. J Neurosurg Pediatr 8:177183, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 117

    Paul KS, , Lye RH, , Strang FA, & Dutton J: Arnold-Chiari malformation. Review of 71 cases. J Neurosurg 58:183187, 1983

  • 118

    Perrini P, , Benedetto N, , Tenenbaum R, & Di Lorenzo N: Extra-arachnoidal cranio-cervical decompression for syringomyelia associated with Chiari I malformation in adults: technique assessment. Acta Neurochir (Wien) 149:10151023, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 119

    Pillay PK, , Awad IA, , Little JR, & Hahn JF: Symptomatic Chiari malformation in adults: a new classification based on magnetic resonance imaging with clinical and prognostic significance. Neurosurgery 28:639645, 1991

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 120

    Pinna G, , Alessandrini F, , Alfieri A, , Rossi M, & Bricolo A: Cerebrospinal fluid flow dynamics study in Chiari I malformation: implications for syrinx formation. Neurosurg Focus 8:3 E3, 2000

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 121

    Prat R, & Galeano I: Pain improvement in patients with syringomyelia and Chiari I malformation treated with suboccipital decompression and tonsillar coagulation. J Clin Neurosci 16:531534, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 122

    Pritz MB: Surgical treatment of Chiari I malformation: simplified technique and clinical results. Skull Base 13:173177, 2003

  • 123

    Raftopoulos C, , Sanchez A, , Matos C, , Balériaux D, , Bank WO, & Brotchi J: Hydrosyringomyelia-Chiari I complex. Prospective evaluation of a modified foramen magnum decompression procedure: preliminary results. Surg Neurol 39:163169, 1993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 124

    Rhoton AL Jr: Microsurgery of Arnold-Chiari malformation in adults with and without hydromyelia. J Neurosurg 45:473483, 1976

  • 125

    Romero FR, & Pereira CA: Suboccipital craniectomy with or without duraplasty: what is the best choice in patients with Chiari type 1 malformation?. Arq Neuropsiquiatr 68:623626, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 126

    Rowlands A, , Sgouros S, & Williams B: Ocular manifestations of hindbrain-related syringomyelia and outcome following craniovertebral decompression. Eye (Lond) 14:884888, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 127

    Saez RJ, , Onofrio BM, & Yanagihara T: Experience with Arnold-Chiari malformation, 1960 to 1970. J Neurosurg 45:416422, 1976

  • 128

    Sakamoto H, , Nishikawa M, , Hakuba A, , Yasui T, , Kitano S, & Nakanishi N, et al.: Expansive suboccipital cranioplasty for the treatment of syringomyelia associated with Chiari malformation. Acta Neurochir (Wien) 141:949961, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 129

    Sakas DE, , Korfias SI, , Wayte SC, , Beale DJ, , Papapetrou KP, & Stranjalis GS, et al.: Chiari malformation: CSF flow dynamics in the craniocervical junction and syrinx. Acta Neurochir (Wien) 147:12231233, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 130

    Sakushima K, , Hida K, , Yabe I, , Tsuboi S, , Uehara R, & Sasaki H: Different surgical treatment techniques used by neurosurgeons and orthopedists for syringomyelia caused by Chiari I malformation in Japan. J Neurosurg Spine 18:588592, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 131

    Schijman E, & Steinbok P: International survey on the management of Chiari I malformation and syringomyelia. Childs Nerv Syst 20:341348, 2004

  • 132

    Schlesinger EB, , Antunes JL, , Michelsen WJ, & Louis KM: Hydromyelia: clinical presentation and comparison of modalities of treatment. Neurosurgery 9:356365, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 133

    Scott WW, , Fearon JA, , Swift DM, & Sacco DJ: Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis. J Neurosurg Pediatr 12:166170, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 134

    Sengupta DK, , Dorgan J, & Findlay GF: Can hindbrain decompression for syringomyelia lead to regression of scoliosis?. Eur Spine J 9:198201, 2000

  • 135

    Sindou M, , Chávez-Machuca J, & Hashish H: Cranio-cervical decompression for Chiari type I-malformation, adding extreme lateral foramen magnum opening and expansile duroplasty with arachnoid preservation. Technique and long-term functional results in 44 consecutive adult cases—comparison with literature data. Acta Neurochir (Wien) 144:10051019, 2002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 136

    Sindou M, & Gimbert E: Decompression for Chiari type I-malformation (with or without syringomyelia) by extreme lateral foramen magnum opening and expansile duraplasty with arachnoid preservation: comparison with other technical modalities (literature review). Adv Tech Stand Neurosurg 34:85110, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 137

    Spena G, , Bernucci C, , Garbossa D, , Valfrè W, & Versari P: Clinical and radiological outcome of craniocervical osteodural decompression for Chiari I-associated syringomyelia. Neurosurg Rev 33:297304, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 138

    Stevens JM, , Serva WA, , Kendall BE, , Valentine AR, & Ponsford JR: Chiari malformation in adults: relation of morphological aspects to clinical features and operative outcome. J Neurol Neurosurg Psychiatry 56:10721077, 1993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 139

    Takayasu M, , Takagi T, , Hara M, & Anzai M: A simple technique for expansive suboccipital cranioplasty following foramen magnum decompression for the treatment of syringomyelia associated with Chiari I malformation. Neurosurg Rev 27:173177, 2004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 140

    Taricco MA, & Melo LR: Retrospective study of patients with Chiari: malformation submitted to surgical treatment. Arq Neuropsiquiatr 66:2A 184188, 2008

  • 141

    Tognetti F, & Calbucci F: Syringomyelia: syringo-subarachnoid shunt versus posterior fossa decompression. Acta Neurochir (Wien) 123:196197, 1993

  • 142

    Tokuno H, , Hakuba A, , Suzuki T, & Nishimura S: Operative treatment of Chiari malformation with syringomyelia. Acta Neurochir Suppl (Wien) 43:2225, 1988

  • 143

    Tubbs RS, , Beckman J, , Naftel RP, , Chern JJ, , Wellons JC III, & Rozzelle CJ, et al.: Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J Neurosurg Pediatr 7:248256, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 144

    Ur-Rahman N, & Jamjoom ZA: Surgical management of Chiari malformation and syringomyelia: experience in 14 cases. Ann Saudi Med 11:402410, 1991

  • 145

    Valentini L, , Visintini S, , Saletti V, , Chiapparini L, , Estienne M, & Solero CL: Treatment for Chiari 1 malformation (CIM): analysis of a pediatric surgical series. Neurol Sci 32:Suppl 3 S321S324, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 146

    Vanaclocha V, & Saiz-Sapena N: Duraplasty with freeze-dried cadaveric dura versus occipital pericranium for Chiari type I malformation: comparative study. Acta Neurochir (Wien) 139:112119, 1997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 147

    Vanaclocha V, , Saiz-Sapena N, & Garcia-Casasola MC: Surgical technique for cranio-cervical decompression in syringomyelia associated with Chiari type I malformation. Acta Neurochir (Wien) 139:529540, 1997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 148

    Vaquero J, , Martínez R, & Arias A: Syringomyelia-Chiari complex: magnetic resonance imaging and clinical evaluation of surgical treatment. J Neurosurg 73:6468, 1990

  • 149

    Versari PP, , D'Aliberti G, , Talamonti G, & Collice M: Foraminal syringomyelia: suggestion for a grading system. Acta Neurochir (Wien) 125:97104, 1993

  • 150

    Weinberg JS, , Freed DL, , Sadock J, , Handler M, , Wisoff JH, & Epstein FJ: Headache and Chiari I malformation in the pediatric population. Pediatr Neurosurg 29:1418, 1998

  • 151

    Wetjen NM, , Heiss JD, & Oldfield EH: Time course of syringomyelia resolution following decompression of Chiari malformation Type I. J Neurosurg Pediatr 1:118123, 2008

  • 152

    Williams B: The distending force in the production of “communicating syringomyelia”. Lancet 2:189193, 1969

  • 153

    Williams B: On the pathogenesis of syringomyelia: a review. J R Soc Med 73:798806, 1980

  • 154

    Yarbrough CK, , Powers AK, , Park TS, , Leonard JR, , Limbrick DD, & Smyth MD: Patients with Chiari malformation Type I presenting with acute neurological deficits: case series. J Neurosurg Pediatr 7:244247, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 155

    Yeh DD, , Koch B, & Crone KR: Intraoperative ultrasonography used to determine the extent of surgery necessary during posterior fossa decompression in children with Chiari I malformation Type I. J Neurosurg 105:1 Suppl 2632, 2006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 156

    Yilmaz A, , Kanat A, , Musluman AM, , Colak I, , Terzi Y, & Kayacı S, et al.: When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale?. World Neurosurg 75:307313, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 157

    Zamel K, , Galloway G, , Kosnik EJ, , Raslan M, & Adeli A: Intraoperative neurophysiologic monitoring in 80 patients with Chiari I malformation: role of duraplasty. J Clin Neurophysiol 26:7075, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 158

    Zhang Y, , Zhang N, , Qiu H, , Zhou J, , Li P, & Ren M, et al.: An efficacy analysis of posterior fossa decompression techniques in the treatment of Chiari malformation with associated syringomyelia. J Clin Neurosci 18:13461349, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 159

    Zhang ZQ, , Chen YQ, , Chen YA, , Wu X, , Wang YB, & Li XG: Chiari I malformation associated with syringomyelia: a retrospective study of 316 surgically treated patients. Spinal Cord 46:358363, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 506 506 82
Full Text Views 3788 329 5
PDF Downloads 3381 336 7
EPUB Downloads 0 0 0