TY - JOUR
T1 - Low occurrence of long-term subsequent fusion in pediatric patients following decompressive surgery for Chiari malformation
T2 - an institutional review
AU - Kerezoudis, Panagiotis
AU - Everson, Megan C.
AU - Miller, Kai J.
AU - Daniels, David J.
AU - Ahn, Edward S.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/8
Y1 - 2022/8
N2 - Objective: Chiari I malformation is treated with suboccipital craniectomy with cervical laminectomy, a procedure which has been associated with the possibility of pre-existing or iatrogenic occipitocervical instability. The long-term risk of subsequent spinal deformity and need for occipito cervical fusion after standard Chiari decompression in pediatric patients has not yet been characterized. Methods: We queried our institutional electronic database for patients aged 18 and under, with at least 5 years of follow-up, that underwent surgical decompression for Chiari I malformation. Occurrence of subsequent occipitocervical fusion at follow-up comprised the primary endpoint. Cases with myelomeningocele, Chiari II, or fusion at time of decompression were excluded. Results: A total of 30 patients (median age 5.5 years, 60% males) were analyzed. Age distribution was as follows: n = 3 for 0–1 years, n = 11 for 1–5 years, n = 4 for 5–10 years, and n = 12 for 10–18 years. Median tonsillar descent below the foramen magnum was 12.5 mm (interquartile range [IQR]: 10.8–19.5 mm). Syringomyelia was observed in 43%, retroflexion of the dens in 55%, basilar invagination in 6.7%, and medullary kinking in 27%. The median clivo-axial angle was 142° (132–150°). The majority of patients underwent C1 laminectomy (n = 24, 80%), followed by C1-C2 laminectomy (n = 4, 13%), while one patient had C1-upper C2 and C1-C3 laminectomy each, respectively. At a median follow-up of 6.3 years, there was only one patient (3.3% of overall cohort) that underwent subsequent occipitocervical fusion. The patient (4-year-old male) initially had a suboccipital craniectomy with C1 laminectomy and duraplasty and presented with recurrence of posterior headaches and neck pain 4 months after original surgery. We proceeded with occiput-C2 fusion with subsequent resolution of his symptoms. Conclusion: Current analysis shows that in the absence of clinical or imaging features suggestive of craniocervical instability, Chiari I decompressive surgery is associated with very low long-term risk of requiring occipitocervical fusion. This observance can be used to guide surgical treatment decisions, especially in young children with Chiari I malformations.
AB - Objective: Chiari I malformation is treated with suboccipital craniectomy with cervical laminectomy, a procedure which has been associated with the possibility of pre-existing or iatrogenic occipitocervical instability. The long-term risk of subsequent spinal deformity and need for occipito cervical fusion after standard Chiari decompression in pediatric patients has not yet been characterized. Methods: We queried our institutional electronic database for patients aged 18 and under, with at least 5 years of follow-up, that underwent surgical decompression for Chiari I malformation. Occurrence of subsequent occipitocervical fusion at follow-up comprised the primary endpoint. Cases with myelomeningocele, Chiari II, or fusion at time of decompression were excluded. Results: A total of 30 patients (median age 5.5 years, 60% males) were analyzed. Age distribution was as follows: n = 3 for 0–1 years, n = 11 for 1–5 years, n = 4 for 5–10 years, and n = 12 for 10–18 years. Median tonsillar descent below the foramen magnum was 12.5 mm (interquartile range [IQR]: 10.8–19.5 mm). Syringomyelia was observed in 43%, retroflexion of the dens in 55%, basilar invagination in 6.7%, and medullary kinking in 27%. The median clivo-axial angle was 142° (132–150°). The majority of patients underwent C1 laminectomy (n = 24, 80%), followed by C1-C2 laminectomy (n = 4, 13%), while one patient had C1-upper C2 and C1-C3 laminectomy each, respectively. At a median follow-up of 6.3 years, there was only one patient (3.3% of overall cohort) that underwent subsequent occipitocervical fusion. The patient (4-year-old male) initially had a suboccipital craniectomy with C1 laminectomy and duraplasty and presented with recurrence of posterior headaches and neck pain 4 months after original surgery. We proceeded with occiput-C2 fusion with subsequent resolution of his symptoms. Conclusion: Current analysis shows that in the absence of clinical or imaging features suggestive of craniocervical instability, Chiari I decompressive surgery is associated with very low long-term risk of requiring occipitocervical fusion. This observance can be used to guide surgical treatment decisions, especially in young children with Chiari I malformations.
KW - Chiari
KW - Decompression
KW - Fusion
KW - Laminectomy
KW - Pediatric
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U2 - 10.1007/s00381-022-05550-3
DO - 10.1007/s00381-022-05550-3
M3 - Review article
C2 - 35590111
AN - SCOPUS:85130509150
SN - 0256-7040
VL - 38
SP - 1455
EP - 1460
JO - Child's Nervous System
JF - Child's Nervous System
IS - 8
ER -