David S Hersh1,2, Mari L Groves3,4, Frederick A Boop5,6,7. 1. Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, USA. 2. Le Bonheur Children's Hospital, Memphis, TN, USA. 3. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA. 5. Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, USA. frederickboop@gmail.com. 6. Le Bonheur Children's Hospital, Memphis, TN, USA. frederickboop@gmail.com. 7. Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, 38120, USA. frederickboop@gmail.com.
Abstract
PURPOSE: Surgical decision-making in Chiari malformation type I (CM-I) patients tends to depend on the presence of neurological signs and symptoms, syringomyelia, and/or scoliosis, but significant variability exists from center to center. Here, we review the symptoms of CM-I in children and provide an overview of the differences in opinion regarding surgical indications, preferred surgical techniques, and measures of outcome. METHODS: A review of the literature was performed to identify publications relevant to the surgical management of pediatric CM-I patients. RESULTS: Most surgeons agree that asymptomatic patients without syringomyelia should not undergo prophylactic surgery, while symptoms of brainstem compression and/or lower cranial nerve dysfunction warrant surgery. Patients between these extremes, however, remain controversial, as does selection of the most appropriate surgical technique. CONCLUSIONS: The optimal surgical procedure for children with CM-I remains a point of contention, and widespread variability exists between and within centers.
PURPOSE: Surgical decision-making in Chiari malformation type I (CM-I) patients tends to depend on the presence of neurological signs and symptoms, syringomyelia, and/or scoliosis, but significant variability exists from center to center. Here, we review the symptoms of CM-I in children and provide an overview of the differences in opinion regarding surgical indications, preferred surgical techniques, and measures of outcome. METHODS: A review of the literature was performed to identify publications relevant to the surgical management of pediatric CM-I patients. RESULTS: Most surgeons agree that asymptomatic patients without syringomyelia should not undergo prophylactic surgery, while symptoms of brainstem compression and/or lower cranial nerve dysfunction warrant surgery. Patients between these extremes, however, remain controversial, as does selection of the most appropriate surgical technique. CONCLUSIONS: The optimal surgical procedure for children with CM-I remains a point of contention, and widespread variability exists between and within centers.
Authors: Todd C Hankinson; Paul Klimo; Neil A Feldstein; Richard C E Anderson; Douglas Brockmeyer Journal: Neurosurg Clin N Am Date: 2007-07 Impact factor: 2.509
Authors: Leslie A Aitken; Camilla E Lindan; Stephen Sidney; Nalin Gupta; A James Barkovich; Michael Sorel; Yvonne W Wu Journal: Pediatr Neurol Date: 2009-06 Impact factor: 3.372
Authors: R Shane Tubbs; Michael J Lyerly; Marios Loukas; Mohammadali M Shoja; W Jerry Oakes Journal: Childs Nerv Syst Date: 2007-07-18 Impact factor: 1.475
Authors: Laurence Davidson; Tiffany N Phan; John S Myseros; Suresh N Magge; Chima Oluigbo; Carlos E Sanchez; Robert F Keating Journal: Childs Nerv Syst Date: 2020-11-23 Impact factor: 1.475
Authors: Irene Stella; Thomas Remen; Arthur Petel; Anthony Joud; Olivier Klein; Philippe Perrin Journal: BMJ Open Date: 2022-05-12 Impact factor: 3.006