Travis J Atchley1, Elizabeth N Alford1, Brandon G Rocque2. 1. Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. 2. Division of Pediatric Neurosurgery, Children's of Alabama-University of Alabama at Birmingham, Lowder Bldg., Suite 400, 1600 7th Ave. S, Birmingham, AL, 35233, USA. Brandon.rocque@childrensal.org.
Abstract
PURPOSE: Previous studies have attempted to evaluate the utility of preoperative magnetic resonance imaging (MRI) parameters in predicting outcomes in Chiari I malformation. We performed a systematic review and meta-analysis to determine what preoperative imaging features (if any) predict (1) presence of preoperative symptoms or associated findings, (2) need for surgical decompression, or (3) improvement after surgical decompression. METHODS: All publications through June 2018 on PubMed, Embase, and Cochrane Library databases were searched using the keywords "Chiari I malformation" AND "decompression" OR "imaging." One thousand two hundred ten publications were identified, and 20 were included for our systematic review; nine were included in the meta-analysis. RESULTS: Tonsil position, clivus gradient, and scoliotic curve of > 20° were all associated with the presence of preoperative syrinx. Degree of scoliotic curve was associated with length of syrinx. Pre-operative findings of central syrinx morphology, shorter syrinx, and scoliotic curve < 20° were associated with post-operative stability/improvement. Post-operative symptomatic improvement was associated with preoperative pB-C2 line ≥ 3 mm, absence of scoliosis, and presence of syrinx. By meta-analysis, there was no significant difference in post-operative improvement between patients with and without syrinx (OR = 0.89; 95% CI 0.58-1.37). Meta-analysis showed no significant difference in post-operative improvement between patients with and without basilar invagination (OR = 1.31; 95% CI 0.72-2.36). CONCLUSIONS: Multiple studies have attempted to identify preoperative imaging parameters to predict post-operative improvement, but no consistently reliable criteria have been defined. This review and meta-analysis highlight the importance of considering each patient's clinical history and physical exam within the context of associated radiographic abnormalities.
PURPOSE: Previous studies have attempted to evaluate the utility of preoperative magnetic resonance imaging (MRI) parameters in predicting outcomes in Chiari I malformation. We performed a systematic review and meta-analysis to determine what preoperative imaging features (if any) predict (1) presence of preoperative symptoms or associated findings, (2) need for surgical decompression, or (3) improvement after surgical decompression. METHODS: All publications through June 2018 on PubMed, Embase, and Cochrane Library databases were searched using the keywords "Chiari I malformation" AND "decompression" OR "imaging." One thousand two hundred ten publications were identified, and 20 were included for our systematic review; nine were included in the meta-analysis. RESULTS: Tonsil position, clivus gradient, and scoliotic curve of > 20° were all associated with the presence of preoperative syrinx. Degree of scoliotic curve was associated with length of syrinx. Pre-operative findings of central syrinx morphology, shorter syrinx, and scoliotic curve < 20° were associated with post-operative stability/improvement. Post-operative symptomatic improvement was associated with preoperative pB-C2 line ≥ 3 mm, absence of scoliosis, and presence of syrinx. By meta-analysis, there was no significant difference in post-operative improvement between patients with and without syrinx (OR = 0.89; 95% CI 0.58-1.37). Meta-analysis showed no significant difference in post-operative improvement between patients with and without basilar invagination (OR = 1.31; 95% CI 0.72-2.36). CONCLUSIONS: Multiple studies have attempted to identify preoperative imaging parameters to predict post-operative improvement, but no consistently reliable criteria have been defined. This review and meta-analysis highlight the importance of considering each patient's clinical history and physical exam within the context of associated radiographic abnormalities.
Entities:
Keywords:
Chiari I malformation; Meta-analysis; Posterior fossa decompression; Systematic review
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