Scoliosis Associated With Chiari I Malformations: The Effect of Suboccipital Decompression on Scoliosis Curve Progression

Brockmeyer, Douglas L.; Gollogly, Sohrab; Smith, John T.

doi:10.1097/01.brs.0000092381.05229.87

Cited by 105 publications

(75 citation statements)

References 12 publications

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“…Our observations are similar to those previously reported that suggest that either a Cobb angle Ͼ 30°1 , 3 or Ͼ 40°8 is a predictor of curvature progression. Furthermore, we found that the spinal level involved in scoliosis was also indicative of postsurgical outcomes.…”

Section: Discussionsupporting

confidence: 82%

“…It is not surprising that the decrease in syrinx size correlates with scoliosis improvement, as the syrinx is likely to be the cause of the scoliotic curve, and previous studies have commonly noted the occurrence of scoliosis in up to 60% of patients with syrinx. 1,3,[6][7][8][9]12 In our scoliosis cohort there was a predominance of females, constituting 80% of our series. This was a natural variant of our population, as we did not include or exclude patients on the basis of sex.…”

Section: Discussionmentioning

confidence: 99%

“…In their study involving hindbrain decompression, Hida et al 9 reported improvement of the curvature in 38%, stabilization in 38%, and progression in 23%. Brockmeyer et al 3 found that patients who were male, under the age of 10 years, and with preoperative curves Ͻ 40°were more likely to improve after decompressive surgery. Eule et al 6 described a study in which the vast majority of patients Ͻ 8 years of age undergoing decompression alone experienced improvement or stabilization of their curves.…”

Section: Discussionmentioning

confidence: 99%

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Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Attenello¹,

McGirt²,

Atiba³

et al. 2008

PED

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Object Chiari malformation Type I (CM-I) is often associated with scoliosis. It remains unclear which subgroups of patients are most likely to experience progression of spinal deformity after cervicomedullary decompression. The authors' goal was to determine the time frame of curvature progression and assess which patient subgroups are at greatest risk for progression of spinal deformity after surgery. Methods The authors retrospectively reviewed the records of all pediatric patients with significant scoliosis in whom suboccipital decompression was performed to treat for CM-I during a 10-year period at a single academic institution. Clinical, radiological, and operative variables were assessed as independent factors for failure (worsening of scoliosis) by using a univariate regression analysis. Results Twenty-one children (mean age 9 ± 3 years; 4 male) underwent hindbrain decompression for CM-I–associated scoliosis and were followed for a mean of 39 months. All patients harbored a syrinx. Eight patients (38%) experienced improvement in scoliosis curvature, whereas 10 (48%) suffered a progression. Thoracolumbar junction scoliosis (p = 0.04) and failure of the syrinx to improve (p = 0.05) were associated with 5- and 4-fold respective increases in the likelihood of deformity progression. Each increasing degree of preoperative Cobb angle was associated with an 11% increase in the likelihood of scoliotic curve progression (p < 0.05). Conclusions Over one third of patients with CM-I–associated scoliosis will improve after cervicomedullary decompression alone. Cervicomedullary decompression is a good first-line option, particularly in children with concordant posterior fossa symptoms. Patients presenting with more severe scoliosis (increasing Cobb angle) or scoliosis that crosses the thoracolumbar junction may benefit from earlier orthopedic involvement and should be monitored regularly for curvature progression after cervicomedullary decompression. In cases in which there is a failure of the syrinx to show improvement after suboccipital decompression, the patients are also more likely to develop curvature progression.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Attenello¹,

McGirt²,

Atiba³

et al. 2008

PED

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“…Combined series, which included both pediatric and adult patients, constituted 61 reports (42%). [5][6][7]9,11,12,[25][26][27]34,37,38,40,43,44,46,47,52,53,55,63,66,67,70,73,74,76,83,87,90,91,94,96,100,102,103,106,110,111,114,115,117,121,126,127,129,130,132,135,[138][139][140]…”

Section: General Informationmentioning

confidence: 99%

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Arnautovic

Splavski

Boop

et al. 2015

PED

204

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OBJECT Chiari malformation Type I (CM-I) is a hindbrain disorder associated with elongation of the cerebellar tonsils, which descend below the foramen magnum into the spinal canal. It occurs in children and adults. Clinical symptoms mainly develop from alterations in CSF flow at the foramen magnum and the common subsequent development of syringomyelia. METHODS The authors reviewed English-language reports of pediatric, adult, and combined (adult and pediatric) surgical series of patients with CM-I published from 1965 through August 31, 2013, to investigate the following: 1) geographical distribution of reports; 2) demographics of patients; 3) follow-up lengths; 4) study durations; 5) spectrum and frequency of surgical techniques; 6) outcomes for neurological status, syrinx, and headache; 7) frequency and scope of complications; 8) mortality rates; and 9) differences between pediatric and adult populations. Research and inclusion criteria were defined, and all series that contained at least 4 cases and all publications with sufficient data for analysis were included. RESULTS The authors identified 145 operative series of patients with CM-I, primarily from the United States and Europe, and divided patient ages into 1 of 3 categories: adult (> 18 years of age; 27% of the cases), pediatric (≤ 18 years of age; 30%), or unknown (43%). Most series (76%) were published in the previous 21 years. The median number of patients in the series was 31. The mean duration of the studies was 10 years, and the mean follow-up time was 43 months. The peak ages of presentation in the pediatric studies were 8 years, followed by 9 years, and in the adult series, 41 years, followed by 46 years. The incidence of syringomyelia was 65%. Most of the studies (99%) reported the use of posterior fossa/foramen magnum decompression. In 92%, the dura was opened, and in 65% of these cases, the arachnoid was opened and dissected; tonsillar resection was performed in 27% of these patients. Postoperatively, syringomyelia improved or resolved in 78% of the patients. Most series (80%) reported postoperative neurological outcomes as follows: 75% improved, 17% showed no change, and 9% experienced worsening. Postoperative headaches improved or resolved in 81% of the patients, with a statistical difference in favor of the pediatric series. Postoperative complications were reported for 41% of the series, most commonly with CSF leak, pseudomeningocele, aseptic meningitis, wound infection, meningitis, and neurological deficit, with a mean complication rate of 4.5%. Complications were reported for 37% of pediatric, 20% of adult, and 43% of combined series. Mortality was reported for 11% of the series. No difference in mortality rates was seen between the pediatric and adult series. CONCLUSIONS Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications. Furthermore, surgeons may benefit from comparing published data with their own. In the future, operative CM-I reports should provide all details of each case for the purpose of comparison.

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“…4,11,25,26,32,35,42 High rates of radiographic syrinx improvement have been reported after PFD with dural opening in pediatric CM-I, with symptom resolution often occurring prior to syrinx resolution and scoliosis improvement often occurring after. [1][2][3][4][5][6][7][8][10][11][12][15][16][17]20,26,27,[29][30][31][32][33][34][35]42,44 In part because syrinx improvement has been noted to occur in the majority of 17,19,36,39 At the 2006 American Society of Pediatric Neurosurgeons meeting, for example, a survey of 50% of the membership demonstrated that for children with a symptomatic CM-I and syrinx, only 4% would perform nondural opening surgery and another 4% would use ultrasound to guide whether to add duraplasty, with the vast majority opting for duraplasty with or without tonsillar resection. 36 However, controversy exists over whether the dura must be opened for successful surgery for pediatric CM-I with or without a syrinx, with good clinical outcomes being reported for a variety of methods.…”

Section: Discussionmentioning

confidence: 99%

Delayed resolution of syrinx after posterior fossa decompression without dural opening in children with Chiari malformation Type I

Kennedy¹,

Nelp²,

Kelly³

et al. 2015

PED

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OBJECT Chiari malformation Type I (CM-I) is associated with a syrinx in 25%–85% of patients. Although posterior fossa decompression (PFD) without dural opening is an accepted treatment option for children with symptomatic CM-I, many surgeons prefer to open the dura if a syrinx exists. The purpose of this study was to investigate the frequency and timing of syrinx resolution in children undergoing PFD without dural opening for CM-I. METHODS A retrospective review of 68 consecutive pediatric patients with CM-I and syringomyelia who underwent PFD without dural opening was conducted. Patient demographics, presenting symptoms and signs, radiographic findings, and intraoperative ultrasound and neuromonitoring findings were studied as well as the patients’ clinical and radiographic follow-up. RESULTS During the mean radiographic follow-up period of 32 months, 70% of the syringes improved. Syrinx improvement occurred at a mean of 31 months postoperatively. All patients experienced symptom improvement within the 1st year, despite only 26% of patients showing radiographic improvement during that period. Patients presenting with sensory symptoms or motor weakness had a higher likelihood of having radiographic syrinx improvement postoperatively. CONCLUSIONS In children with CM-I and a syrinx undergoing PFD without dural opening, syrinx resolution occurs in approximately 70% of patients. Radiographic improvement of the syrinx is delayed, but this does not correlate temporally with symptom improvement. Sensory symptoms or motor weakness on presentation are associated with syrinx resolution after surgery.

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Scoliosis Associated With Chiari I Malformations: The Effect of Suboccipital Decompression on Scoliosis Curve Progression

Cited by 105 publications

References 12 publications

Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Suboccipital decompression for Chiari malformation–associated scoliosis: risk factors and time course of deformity progression

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Delayed resolution of syrinx after posterior fossa decompression without dural opening in children with Chiari malformation Type I

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