Surgical outcome of Chiari I malformation in children: clinico-radiological factors and technical aspects

• Published in: Child's nervous system 2014-04, Vol.30 (4), p.613-623
• Main Authors: Lee, Sungjoon, Wang, Kyu-Chang, Cheon, Jung-Eun, Phi, Ji Hoon, Lee, Ji Yeoun, Cho, Byung-Kyu, Kim, Seung-Ki
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Original Paper
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-013-2263-9

Purpose The optimal treatment for Chiari I malformation in children is still under debate. The aim of this study was to evaluate the surgical outcome of the pediatric Chiari I malformation, focusing on clinico-radiological factors and technical aspects. Methods Fifty-six patients with Chiari I malformation who received surgery at Seoul National University Children’s Hospital were included. The mean age was 7.9 years. The patients were divided into three groups: group I ( n  = 8) with hydrocephalus, group II ( n  = 11) without syrinx, and group III ( n  = 37) with syrinx. Group I received shunting operation initially, and others received foramen magnum decompression (FMD). Group III was further subdivided: group IIIa ( n  = 9), minimal intradural manipulation, and group IIIb ( n  = 27), active intradural manipulation. The outcomes were compared between the groups. The mean follow-up period was 75.9 months. Results In group I, symptoms were resolved or had improved in most patients, with only one patient received additional FMD. Symptoms resolved or improved in 10 (91 %) and 25 cases (84 %) in groups II and III, respectively. Syrinx was markedly decreased in 31 cases (86 %) in group III. FMD was less effective for scoliosis (improved or stabilized in 57 %). The persistence of syrinx was related with an aggravation of scoliosis. The outcomes between group IIIa and IIIb showed no significant difference. Conclusions In most pediatric Chiari I patients with hydrocephalus, a shunting operation was sufficient. FMD showed high efficacy in treating patients without hydrocephalus. The extent of the intradural procedure did not have a significant effect on the clinical outcome.