Outcomes and complications for individual neurosurgeons for the treatment of Chiari I malformation at a children’s hospital

Walker-Palmer, Tasha-Kay; Cochrane, D. Douglas; Singhal, Ash; Steinbok, Paul

doi:10.1007/s00381-019-04201-4

Cited by 8 publications

(14 citation statements)

References 76 publications

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“…The average score or the groups that the patients fall varies depending on several factors like the duration of symptoms, variability of symptoms, abundance of surgical techniques or range of follow up periods. 28,[33][34][35] Altogether most of the patients in our series had functional outcome considering SC alone, two third of the patients had excellent outcome. In most of the other series, the general outcome with CCOS improved gradually with time and varied noticeably depending on different factors.…”

Section: Discussionmentioning

confidence: 57%

“…Most of the studies on adult CM1 patients show that the average CCOS that could be achieved ranges between 13 to 14.5. 25,28,[33][34][35] Most of the patients in different series succeeded in achieving excellent outcome on average with good CCOS. The average score or the groups that the patients fall varies depending on several factors like the duration of symptoms, variability of symptoms, abundance of surgical techniques or range of follow up periods.…”

Section: Discussionmentioning

confidence: 95%

“…31,32 CCOS is being used widely to assess postoperative outcome of CM1 patients and has become a reliable tool. 25,27,33,34 Post-operative outcome can be measured with CCOS in 2 ways; by assessing improvement with the overall score and by categorizing the patient into functional outcome groups based on that score. Most of the studies on adult CM1 patients show that the average CCOS that could be achieved ranges between 13 to 14.5.…”

Section: Discussionmentioning

confidence: 99%

“…Complication rate varies from zero complication to as high as 33.3% in different series. 25,27,30,33,34,36 Common complications include cerebrospinal fluid leak, pseudomeningocele, meningitis, wound infection, hydrocephalus, subdural collections, and often a less common cerebellar slump or ptosis. 26,27,30,34,37 It is well established that the complication rates, particularly the CSF related ones occur more following procedures that breach the arachnoid, while extradural or arachnoid preserving procedures are evidently better in avoiding CSF related complications.…”

Section: Discussionmentioning

confidence: 99%

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Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Rahman

Alam

et al. 2023

Bangabandhu Sheikh Mujib Medical Univ J

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Background: The surgical management of symptomatic adult Chiari malformation type 1 (CM1) with or without syringomyelia (SM) continues to be a dilemma considering the outcomes. Objectives: The study aimed to compare the clinical outcomes between stealth cranioplasty (SC) and one of the most commonly practiced standard procedures, posterior fossa decompression with duraplasty (PFDD). Clinical outcomes between SC and another procedure posterior fossa decompression (PFD) were also compared. Methods: This comparative cross-sectional study was carried out on 37 males and 16 females symptomatic adult CM1 patients, ranging from 18 to 47 years of age from June 2019 to May 2021. Clinical outcomes were assessed, compared, and analyzed in terms of changes in clinical symptoms and signs, chicago chiari outcome scale (CCOS) score, and occurrence of complications. Results: Of the 53 patients, 23, 19 and 11 underwent SC, PFDD, and PFD, respectively. There were no significant post-operative changes in symptoms and signs among groups except changes in limb weakness between SC and PFDD (P=0.004). Considering average CCOS score, SC performed better only than PFDD (P=0.003), while category-wise SC was better than both PFDD (P=0.004) and PFD (P=0.010). Considering complications, the PFDD group had a significantly higher rate of complications than the SC group (P=0.001), while there was no significant difference in the rate of complications between the PFD and SC groups. Conclusion: SC was found to have better clinical outcomes than the PFDD and PFD groups as a technique. Bangabandhu Sheikh Mujib Medical University Journal 2023;16(1): 08-16

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Rahman

Alam

et al. 2023

Bangabandhu Sheikh Mujib Medical Univ J

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“…6 However, traditional PFDD carries significant postoperative risk in terms of pseudomeningocele formation, cerebrospinal fluid (CSF) leak, and wound revision. 7-16 Furthermore, the postoperative scar that extends below the hairline after traditional PFDD may have unintended psychosocial consequences, particularly in pediatric and adolescent patients. Given these limitations, we sought a novel approach to PFDD for Chiari malformation type 1 that might improve both the wound-related postoperative complication rates and cosmesis.…”

mentioning

confidence: 99%

Above-The-Hairline Suboccipital Transverse Approach for the Treatment of Chiari I Malformation

Naylor

Rotter

Proctor

et al. 2023

Operative Neurosurgery

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BACKGROUND: Chiari I malformation is a common pediatric neurosurgical disorder with an established treatment paradigm. Posterior fossa decompression and duraplasty (PFDD) is associated with symptom improvement but it carries postoperative risk, particularly cerebrospinal fluid (CSF) leak and wound complications. In addition, the cosmetic outcomes of PFDD have been overlooked in the literature. OBJECTIVE: To describe a novel approach for PFDD in which the transverse surgical incision is completely hidden above the hairline and to report early outcomes in a prospective patient cohort. METHODS: Clinical and cosmetic outcomes were recorded for 15 consecutive pediatric patients who underwent PFDD for Chiari I malformation via the above-the-hairline transverse suboccipital approach. RESULTS: The median clinical follow-up time was 6 months (range 1-12 months), and the majority of patients experienced significant improvement of their preoperative symptoms. Three patients (20%) experienced complications associated with surgery, which included injury to the greater occipital nerve, CSF hypotension and subfascial pseudomeningocele, and superficial wound dehiscence that resolved spontaneously with oral antibiotics. Zero patients (0%) returned to the operating room for persistent CSF leak, deep wound infection, or revision decompression. An excellent cosmetic outcome was achieved in 12 patients (80%). No patient had a poor cosmetic outcome. CONCLUSION: The above-the-hairline transverse suboccipital approach for PFDD in patients with Chiari I malformation offers favorable cosmetic outcomes and fascial closure while permitting adequate decompression.

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Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure?

et al. 2021

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Outcomes and complications for individual neurosurgeons for the treatment of Chiari I malformation at a children’s hospital

Cited by 8 publications

References 76 publications

Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Stealth cranioplasty in symptomatic adult chiari 1 malformations: Experience at Bangabandhu Sheikh Mujib Medical University

Above-The-Hairline Suboccipital Transverse Approach for the Treatment of Chiari I Malformation

Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure?

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