BACKGROUND: Outcome assessment for the management of Chiari malformation type 1 is difficult because of the lack of a reliable and specific surgical outcome assessment scale. Such a scale could reliably correlate postoperative outcomes with preoperative symptoms. OBJECTIVE: We developed a novel scoring system and applied it retrospectively to 146 patients treated at our institution in order to create and verify a simple and quantifiable assessment of Chiari outcomes. METHODS: The Chicago Chiari Outcome Scale (CCOS) uses 4 postoperative outcome categories (pain, nonpain symptoms, functionality, and complications) graded 1 to 4 for a total possible score of 16. As a comparison with current Chiari outcome methodology, each patient was also placed into a gestalt outcome group of "improved," "unchanged," or "worse" (I/U/W). Patients were stratified by CCOS scores and by I/U/W group. RESULTS: Stratifying patients by total CCOS scores showed that patients who achieved CCOS scores between 13 and 16 were predominantly in the I/U/W improved group (n = 101, 69%); scores between 9 and 12 were predominantly I/U/W unchanged (n = 39, 27%), and scores between 4 and 8 were I/U/W worse (n = 6, 4%). Symptom subscore results provided insight into the specifics of the overall outcome in addition to the more quantitative nature of the 16-point scale. CONCLUSION: We describe a CCOS that assigns higher scores to patients judged improved by gestalt I/U/W ratings and lower scores to those who were unchanged or worse while defining outcome in 4 specific subcategories. As such, this CCOS should allow for a more unified and quantifiable outcome assessment after Chiari surgery.
BACKGROUND: Outcome assessment for the management of Chiari malformation type 1 is difficult because of the lack of a reliable and specific surgical outcome assessment scale. Such a scale could reliably correlate postoperative outcomes with preoperative symptoms. OBJECTIVE: We developed a novel scoring system and applied it retrospectively to 146 patients treated at our institution in order to create and verify a simple and quantifiable assessment of Chiari outcomes. METHODS: The Chicago Chiari Outcome Scale (CCOS) uses 4 postoperative outcome categories (pain, nonpain symptoms, functionality, and complications) graded 1 to 4 for a total possible score of 16. As a comparison with current Chiari outcome methodology, each patient was also placed into a gestalt outcome group of "improved," "unchanged," or "worse" (I/U/W). Patients were stratified by CCOS scores and by I/U/W group. RESULTS: Stratifying patients by total CCOS scores showed that patients who achieved CCOS scores between 13 and 16 were predominantly in the I/U/W improved group (n = 101, 69%); scores between 9 and 12 were predominantly I/U/W unchanged (n = 39, 27%), and scores between 4 and 8 were I/U/W worse (n = 6, 4%). Symptom subscore results provided insight into the specifics of the overall outcome in addition to the more quantitative nature of the 16-point scale. CONCLUSION: We describe a CCOS that assigns higher scores to patients judged improved by gestalt I/U/W ratings and lower scores to those who were unchanged or worse while defining outcome in 4 specific subcategories. As such, this CCOS should allow for a more unified and quantifiable outcome assessment after Chiari surgery.
Authors: Braden J Lawrence; Mark Luciano; John Tew; Richard G Ellenbogen; John N Oshinski; Francis Loth; Amanda P Culley; Bryn A Martin Journal: World Neurosurg Date: 2018-05-04 Impact factor: 2.104
Authors: Mark G Luciano; Ulrich Batzdorf; Roger W Kula; Brandon G Rocque; Cormac O Maher; John Heiss; Bryn A Martin; Paolo A Bolognese; Allison Ashley-Koch; David Limbrick; Dorothy J Poppe; Kaitlyn M Esposito; Joanne Odenkirchen; Joy R Esterlitz; Sherita Ala'i; Kristen Joseph; Robin S Feldman; Robert Riddle Journal: Neurosurgery Date: 2019-12-01 Impact factor: 4.654
Authors: Alireza Radmanesh; Jacob K Greenberg; Arindam Chatterjee; Matthew D Smyth; David D Limbrick; Aseem Sharma Journal: Neuroradiology Date: 2015-01-07 Impact factor: 2.804
Authors: Jacob K Greenberg; Chester K Yarbrough; Alireza Radmanesh; Jakub Godzik; Megan Yu; Donna B Jeffe; Matthew D Smyth; Tae Sung Park; Jay F Piccirillo; David D Limbrick Journal: Neurosurgery Date: 2015-03 Impact factor: 4.654
Authors: Amy Lee; Chester K Yarbrough; Jacob K Greenberg; Jason Barber; David D Limbrick; Matthew D Smyth Journal: Childs Nerv Syst Date: 2014-04-29 Impact factor: 1.475