The role of cine flow MRI in children with Chiari I malformation

Ventureyra, Enrique C. G.; Aziz, Hani Abdel; Vassilyadi, Michael

doi:10.1007/s00381-002-0701-1

Cited by 111 publications

(52 citation statements)

References 25 publications

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“…In recent years, investigators have published several series examining the outcome from extradural decompression for CM1 compared to the more-invasive decompression with duraplasty [8, 13, 16, 17, 22–24]. Such studies have focused primarily on operative morbidity, postoperative complications rates, and repeat surgery for persistent disease.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies, including a meta-analysis by Durham and colleagues [6, 13, 17], have found PFDO associated with higher rates of reoperation for persistent disease, evidence suggesting a difference in symptomatic outcome is mixed [8, 13, 23, 24]. Though not statistically significant in meta-analysis, some findings also show higher rates of syrinx improvement in patients undergoing PFDD [6, 17, 22], leading many physicians to avoid extradural decompression in patients with syringomyelia [20]. However, these previous studies had important limitations: first, these studies lacked treatment groups that were balanced on demographic variables, presenting symptoms, and radiographic findings; second, the methods used to report clinical outcomes were poorly defined and not based on any validated metrics.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation

et al. 2014

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Purpose Chiari Malformation Type I (CM1) is a common and often debilitating neurosurgical disease. Whether to treat CM1 patients with a traditional posterior fossa decompression with duraplasty (PFDD) or a less invasive extradural decompression (PFDO) is controversial. The purpose of this study was to compare clinical outcome and syrinx resolution between the two procedures. Methods We retrospectively reviewed the records of 36 patients treated with PFDD and 29 patients with PFDO between 2003 and 2011. We compared baseline demographic, clinical, and radiographic characteristics. The primary clinical outcome was the Chicago Chiari Outcome Scale (CCOS). The primary radiographic outcome was qualitative syrinx improvement or resolution. Results At baseline, age and sex distributions, radiographic characteristics, and presenting symptoms were similar in patients undergoing PFDD and PFDO. Patients undergoing PFDO had shorter surgical time (1.5 vs. 2.8 hours; p < 0.001) and length of hospital stay (2.1 compared to 3.3 days; p < 0.001). Cerebrospinal fluid-related complications were more common in patients receiving PFDD (7/36) than PFDO (0/29) (p=0.014). Clinical improvement, defined by the mean CCOS score, was comparable in patients receiving PFDO (14.7) and PFDD (14.6) (p=0.70). Among patients with postoperative syrinx imaging, 10/13 in the PFDD group improved or resolved, compared to 8/8 in the PFDO group (p=0.26). Conclusions Extradural decompression for CM1 produces comparable rates of clinical and radiographic improvement as the more-invasive decompression with duraplasty. Given the increased morbidity and resource utilization associated with PFDD, PFDO should be considered an attractive first-line option for most CM1 patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation

et al. 2014

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“…The diagnosis of Chiari type I malformation in patients with or without symptoms is established with neuroimaging techniques; the preferred technique is magnetic resonance imaging (MRI) [20]. MRI can also be used to study the volume of the posterior fossa and CSF flow dynamics.…”

Section: Diagnosismentioning

confidence: 99%

“…The role of the medical professional is to provide up-to-date information, such as details of referrals and recommendations for other professionals, investigations developed, and recommended therapies [20]. …”

Section: Psychological Issuesmentioning

confidence: 99%

Malformations of the craniocervical junction (chiari type I and syringomyelia: classification, diagnosis and treatment)

Fernández

Guerrero

Martínez

et al. 2009

BMC Musculoskelet Disord

138

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Chiari disease (or malformation) is in general a congenital condition characterized by an anatomic defect of the base of the skull, in which the cerebellum and brain stem herniate through the foramen magnum into the cervical spinal canal. The onset of Chiari syndrome symptoms usually occurs in the second or third decade (age 25 to 45 years). Symptoms may vary between periods of exacerbation and remission. The diagnosis of Chiari type I malformation in patients with or without symptoms is established with neuroimaging techniques. The most effective therapy for patients with Chiari type I malformation/syringomyelia is surgical decompression of the foramen magnum, however there are non-surgical therapy to relieve neurophatic pain: either pharmacological and non-pharmacological. Pharmacological therapy use drugs that act on different components of pain. Non-pharmacological therapies are primarly based on spinal or peripheral electrical stimulation.It is important to determine the needs of the patients in terms of health-care, social, educational, occupational, and relationship issues, in addition to those derived from information aspects, particularly at onset of symptoms.Currently, there is no consensus among the specialists regarding the etiology of the disease or how to approach, monitor, follow-up, and treat the condition.It is necessary that the physicians involved in the care of people with this condition comprehensively approach the management and follow-up of the patients, and that they organize interdisciplinary teams including all the professionals that can help to increase the quality of life of patients.

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“…Other groups have published case series with outcomes split into “better, unchanged, or worse” categories. 5,9,13,17,18 A similar assessment algorithm has been in use at our institution, though this classification is highly subjective and poorly suited for assessing outcomes within or between individuals. More recently, the Chicago Chiari Outcome Scale (CCOS) was developed to address outcomes with a more complete approach to the variety of symptoms patients may experience (see Table 1).…”

Section: Introductionmentioning

confidence: 99%

External validation of the Chicago Chiari Outcome Scale

Yarbrough¹,

Greenberg²,

Smyth³

et al. 2014

PED

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Object Historically, assessment of clinical outcomes following surgical management of Chiari malformation Type I (CM-I) has been challenging due to the lack of a validated instrument for widespread use. The Chicago Chiari Outcome Scale (CCOS) is a novel system intended to provide a less subjective evaluation of outcomes for patients with CM-I. The goal of this study was to externally validate the performance of the CCOS. Methods Patients undergoing surgery for CM-I between 2001 and 2012 were reviewed (n = 292). Inclusion criteria for this study were as follows: 1) patients receiving primary posterior fossa decompression; 2) at least 5.5 months of postoperative clinical follow-up; and 3) patients ≤ 18 years of age at the time of surgery. Outcomes were evaluated using the CCOS, along with a “gestalt” impression of whether patients experienced significant improvement after surgery. A subgroup of 118 consecutive patients undergoing operations between 2008 and 2010 was selected for analysis of interrater reliability (n = 73 meeting inclusion/exclusion criteria). In this subgroup, gestalt and CCOS scores were independently determined by 2 reviewers, and interrater reliability was assessed using the intraclass correlation coefficient (ICC) and kappa (κ) statistic. Results The median CCOS score was 14, and 67% of patients had improved gestalt scores after surgery. Overall, the CCOS was effective at identifying patients with improved outcome after surgery (area under curve = 0.951). The interrater reliability of the CCOS (ICC = 0.71) was high, although the reliability of the component scores ranged from poor to good (ICC 0.23–0.89). The functionality subscore demonstrated a low ICC and did not add to the predictive ability of the logistic regression model (likelihood ratio = 1.8, p = 0.18). When analyzing gestalt outcome, there was moderate agreement between raters (κ = 0.56). Conclusions In this external validation study, the CCOS was effective at identifying patients with improved outcomes and proved more reliable than the authors' gestalt impression of outcome. However, certain component subscores (functionality and nonpain symptoms) were found to be less reliable, and may benefit from further definition in score assignment. In particular, the functionality subscore does not add to the predictive ability of the CCOS, and may be unnecessary. Overall, the authors found the CCOS to be an improvement over the previously used assessment of outcome at their institution.

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The role of cine flow MRI in children with Chiari I malformation

Cited by 111 publications

References 25 publications

Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation

Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation

Malformations of the craniocervical junction (chiari type I and syringomyelia: classification, diagnosis and treatment)

External validation of the Chicago Chiari Outcome Scale

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