Travis S CreveCoeur1, Alexander T Yahanda1, Cormac O Maher2, Gabrielle W Johnson1, Laurie L Ackerman3, P David Adelson4, Raheel Ahmed5, Gregory W Albert6, Phillipp R Aldana7, Tord D Alden8, Richard C E Anderson9, Lissa Baird10, David F Bauer11, Karin S Bierbrauer12, Douglas L Brockmeyer13, Joshua J Chern14, Daniel E Couture15, David J Daniels16, Robert C Dauser17, Susan R Durham18, Richard G Ellenbogen19, Ramin Eskandari20, Herbert E Fuchs21, Timothy M George22, Gerald A Grant23, Patrick C Graupman24, Stephanie Greene25, Jeffrey P Greenfield26, Naina L Gross27, Daniel J Guillaume28, Gabe Haller1, Todd C Hankinson29, Gregory G Heuer30, Mark Iantosca31, Bermans J Iskandar5, Eric M Jackson32, Andrew H Jea3, James M Johnston33, Robert F Keating34, Michael P Kelly35, Nickalus Khan36, Mark D Krieger37, Jeffrey R Leonard38, Francesco T Mangano12, Timothy B Mapstone27, J Gordon McComb37, Arnold H Menezes39, Michael Muhlbauer36, W Jerry Oakes33, Greg Olavarria40, Brent R O'Neill29, Tae Sung Park1, John Ragheb41, Nathan R Selden10, Manish N Shah42, Chevis Shannon43, Joshua S Shimony44, Jodi Smith3, Matthew D Smyth1, Scellig S D Stone45, Jennifer M Strahle1, Mandeep S Tamber46, James C Torner39, Gerald F Tuite47, Scott D Wait48, John C Wellons43, William E Whitehead17, David D Limbrick1. 1. Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri. 2. Department of Neurosurgery, University of Michigan School of Medicine, Ann Arbor, Michigan. 3. Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana. 4. Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona. 5. Department of Neurological Surgery, University of Wisconsin at Madison, Madison, Wisconsin. 6. Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas. 7. Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida. 8. Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 9. Division of Pediatric Neurosurgery, Department of Neurological Surgery, Children's Hospital of New York, Columbia-Presbyterian, New York, New York. 10. Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon. 11. Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 12. Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, Ohio. 13. Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah. 14. Division of Pediatric Neurosurgery, Children's Healthcare of Atlanta, Atlanta, Georgia. 15. Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina. 16. Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota. 17. Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas. 18. Department of Neurosurgery, University of Vermont, Burlington, Vermont. 19. Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, Washington. 20. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina. 21. Department of Neurosurgery, Duke University, Durham, North Carolina. 22. Division of Pediatric Neurosurgery, Dell Children's Medical Center, Austin, Texas. 23. Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Palo Alto, California. 24. Division of Pediatric Neurosurgery, Gillette Children's Hospital, St. Paul, Minnesota. 25. Divsion of Pediatric Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 26. Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York. 27. Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma. 28. Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota. 29. Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado. 30. Division of Pediatric Neurosurgery, Children's Hospital of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 31. Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. 32. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 33. Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama. 34. Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia. 35. Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri. 36. Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee. 37. Department of Neurosurgery, Children's Hospital of Los Angeles, Los Angeles, California. 38. Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio. 39. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa. 40. Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, Florida. 41. Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida. 42. Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas. 43. Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, Tennessee. 44. Department of Radiology, Washington University School of Medicine, St. Louis, Missouri. 45. Division of Pediatric Neurosurgery, Boston Children's Hospital, Boston, Massachusetts. 46. Department of Neurosurgery, The University of British Columbia, Vancouver, Canada. 47. Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, Florida. 48. Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
Abstract
BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P < .001) were increased within the OCF group, whereas only basilar invagination (1/4, P < .001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P = .008) and OCF/VD (115.0 ± 11.6°, P = .025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. CONCLUSION: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.
BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P < .001) were increased within the OCF group, whereas only basilar invagination (1/4, P < .001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P = .008) and OCF/VD (115.0 ± 11.6°, P = .025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. CONCLUSION: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.
Authors: Robert J Bollo; Jay Riva-Cambrin; Meghan M Brockmeyer; Douglas L Brockmeyer Journal: J Neurosurg Pediatr Date: 2012-06-22 Impact factor: 2.375
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Authors: John K Chae; Neelan J Marianayagam; Ibrahim Hussain; Amanda Cruz; Ali A Baaj; Roger Härtl; Jeffrey P Greenfield Journal: J Neurosurg Case Lessons Date: 2021-11-29