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Acta Neurochirurgica

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Open Access 01-12-2024 | Intracranial Hypertension | Original Article

Preoperative estimation of intracranial compliance in symptomatic children with Chiari malformation type 1: impact on outcome and risk of complications

Authors: Radek Frič, Eline Bryne, Bogna Warsza, Bernt Johan Due-Tønnessen, Per Kristian Eide

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Background

The role of reduced intracranial compliance (ICC) in the outcome after foramen magnum decompression (FMD) was demonstrated in adults with Chiari malformation Type 1 (CMI). However, similar observations from children treated for CMI are missing.

Methods

We reviewed pediatric cases of CMI referred to FMD between 2006 and 2022. Children with clinical and/or radiological signs suggesting reduced ICC (Group A) underwent overnight measurements of the pulsatile intracranial pressure (ICP): mean ICP wave amplitude (MWA) served as a surrogate marker of ICC. Children with more typical symptoms of CMI (Group B) underwent FMD without preoperative ICC estimation. This study presents the clinical, radiological, and outcome differences between these groups.

Results

Sixty-four children (mean age 11.1 ± 4.3 years) underwent FMD: In Group A (n = 30), the finding of reduced ICC as estimated from preoperative ICP measurement resulted in CSF diversion (ventriculoperitoneal shunt) before FMD in 11 children. Two patients required shunt due to complications after FMD (total shunt rate 43%). In Group B (n = 34) treated with FMD without preoperative ICC estimation, five children (15%) required shunting due to complications. In Group A, we found a significantly higher frequency of headache, nausea, fatigue, and dizziness. The outcome assessed by the modified Chicago Chiari Outcome Scale (mean follow-up 83 ± 57 months) was comparable between the groups, but the complication rate after FMD was significantly lower in Group A (7% vs. 32%; p = 0.011). The number of procedures (ICP measurement, FMD, shunt, re-do FMD, shunt revisions) was significantly higher in Group A (2.6 ± 0.9 vs. 1.5 ± 1.1 per patient; p < 0.001).

Conclusion

In symptomatic children with CMI, the preoperative estimation of ICC from the overnight measurement of pulsatile ICP was more reliable for identifying those with reduced ICC than clinical and radiological assessment alone. When children with abnormally reduced ICC were identified and treated with CSF diversion before FMD, the complication rate was significantly reduced.

Ahluwalia R, Foster J, Brooks E, Lim J, Zhao S, Gannon SR, Guidry B, Wellons J, Shannon CN (2020) Chiari type I malformation: role of the Chiari Severity Index and Chicago Chiari Outcome Scale. J Neurosurg Pediatr 26:262–268PubMedCrossRef

Aliaga L, Hekman KE, Yassari R, Straus D, Luther G, Chen J, Sampat A, Frim D (2012) A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery 70:656–664; discussion 664–655

Alnemari A, Mansour TR, Gregory S, Miller WK, Buehler M, Gaudin D (2017) Chiari I malformation with underlying pseudotumor cerebri: poor symptom relief following posterior decompression surgery. Int J Surg Case Rep 38:136–141PubMedPubMedCentralCrossRef

Antkowiak L, Stogowski P, Klepinowski T, Balinski T, Mado H, Sumislawski P, Niedbala M, Rucinska M, Nowaczyk Z, Rogalska M, Kocur D, Kasperczuk A, Sordyl R, Kloc W, Kaspera W, Kammler G, Sagan L, Rudnik A, Tabakow P, Westphal M, Mandera M (2023) External validation of the Chicago Chiari Outcome Scale in adults with Chiari malformation type I. Neurosurg Focus 54:E3. https://doi.org/10.3171/2022.12.Focus22625CrossRefPubMed

Arnautovic A, Splavski B, Boop FA, Arnautovic KI (2015) Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr 15:161–177PubMedCrossRef

Bartoli A, Soleman J, Berger A, Wisoff JH, Hidalgo ET, Mangano FT, Keating RF, Thomale UW, Boop F, Roth J, Constantini S (2020) Treatment options for hydrocephalus following foramen magnum decompression for Chiari I malformation: a multicenter study. Neurosurgery 86:500–508PubMedCrossRef

Bejjani GK (2003) Association of the adult chiari malformation and idiopathic intracranial hypertension: more than a coincidence. Med Hypotheses 60:859–863PubMedCrossRef

Braga BP, Montgomery EY, Weprin BE, Price AV, Whittemore BA, Pernik MN, Sklar F, De Oliveira Sillero R, Swift DM (2023) Cerebellar tonsil reduction for surgical treatment of Chiari malformation type I in children. J Neurosurg Pediatr 1–10. https://doi.org/10.3171/2023.1.Peds22222

Cai S, Tian Y, Zhang J, Shen J, Hu J, Chen F (2021) Posterior fossa decompression with or without duraplasty for patients with Chiari type I malformation and basilar impression: a meta-analysis. Eur Spine J 30:454–460PubMedCrossRef

10.

Decq P, Le Guerinel C, Sol JC, Brugieres P, Djindjian M, Nguyen JP (2001) Chiari I malformation: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy. J Neurosurg 95:783–790PubMedCrossRef

11.

Durham SR, Fjeld-Olenec K (2008) Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr 2:42–49PubMedCrossRef

12.

Dyson EW, Chari A, Stevens AR, Thompson SD, Craven C, Haylock-Vize P, Matloob SA, Shah SN, Chan HW, Patel NA, Mostafa T, Ekanayake J, Toma AK, Thorne LW, Watkins LD (2015) Intracranial pressure guided management of patients with Chiari malformations presenting with headache: a paradigm shift? Fluids Barriers CNS 12:O29PubMedCentralCrossRef

13.

Dyson EW, Chari A, Toma AK, Thorne LW, Watkins LD (2020) Failed foramen magnum decompression in Chiari I malformation is associated with failure to restore normal intracranial compliance: an observational cohort study. Neurosurgery 86:E552-e557PubMedCrossRef

14.

Eide PK (2003) The relationship between intracranial pressure and size of cerebral ventricles assessed by computed tomography. Acta Neurochir (Wien) 145:171–179. discussion 179

15.

Eide PK (2006) A new method for processing of continuous intracranial pressure signals. Med Eng Phys 28:579–587PubMedCrossRef

16.

Eide PK (2016) The correlation between pulsatile intracranial pressure and indices of intracranial pressure-volume reserve capacity: results from ventricular infusion testing. J Neurosurg 125:1493–1503PubMedCrossRef

17.

Eide PK, Egge A, Due-Tønnessen BJ, Helseth E (2007) Is intracranial pressure waveform analysis useful in the management of pediatric neurosurgical patients? Pediatr Neurosurg 43:472–481PubMedCrossRef

18.

Eide PK, Sorteberg W (2007) Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with intracranial bleeds. Neurol Res 29:798–802PubMedCrossRef

19.

Evensen KB, Eide PK (2020) Measuring intracranial pressure by invasive, less invasive or non-invasive means: limitations and avenues for improvement. Fluids Barriers CNS 17:34. https://doi.org/10.1186/s12987-020-00195-3CrossRefPubMedPubMedCentral

20.

Frič R, Eide PK (2015) Comparison of pulsatile and static pressures within the intracranial and lumbar compartments in patients with Chiari malformation type 1: a prospective observational study. Acta Neurochir (Wien) 157:1411–1423PubMedCrossRef

21.

Frič R, Eide PK (2016) Perioperative monitoring of pulsatile and static intracranial pressure in patients with Chiari malformation type 1 undergoing foramen magnum decompression. Acta Neurochir (Wien) 158:341–347PubMedCrossRef

22.

Frič R, Eide PK (2017) Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension. J Neurosurg 126:1312–1322PubMedCrossRef

23.

Frič R, Eide PK (2020) Chiari type 1 - a malformation or a syndrome? A critical review. Acta Neurochir (Wien) 162:1513–1525PubMedCrossRef

24.

Frič R, Ringstad G, Eide PK (2023) Low versus high intracranial compliance in adult patients with Chiari malformation Type 1 - comparison of long-term outcome after tailored treatment. World Neurosurg 173:e699–e707. https://doi.org/10.1016/j.wneu.2023.02.134

25.

Gallo P, Sokol D, Kaliaperumal C, Kandasamy J (2017) Comparison of three different cranio-cervical decompression procedures in children with Chiari malformation type I: does the surgical technique matter? Pediatr Neurosurg 52:289–297PubMedCrossRef

26.

Gholampour S (2023) Why intracranial compliance is not utilized as a common practical tool in clinical practice. Biomedicines 11:3083. https://doi.org/10.3390/biomedicines11113083CrossRefPubMedPubMedCentral

27.

Gilmer HS, Xi M, Young SH (2017) Surgical decompression for Chiari malformation type I: an age-based outcomes study based on the Chicago Chiari Outcome Scale. World Neurosurg 107:285–290PubMedCrossRef

28.

Greenberg JK, Milner E, Yarbrough CK, Lipsey K, Piccirillo JF, Smyth MD, Park TS, Limbrick DD Jr (2015) Outcome methods used in clinical studies of Chiari malformation type I: a systematic review. J Neurosurg 122:262–272PubMedCrossRef

29.

Hayhurst C, Osman-Farah J, Das K, Mallucci C (2008) Initial management of hydrocephalus associated with Chiari malformation type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis. J Neurosurg 108:1211–1214PubMedCrossRef

30.

Häckel MBV, Mohapl M (2001) Simultaneous cerebral and spinal fluid pressure recordings in surgical indications of the Chiari malformation without myelodysplasia. Acta Neurochir (Wien) 143:909–917PubMedCrossRef

31.

Jacobsen HH, Jørstad ØK, Moe MC, Petrovski G, Pripp AH, Sandell T, Eide PK (2022) Noninvasive estimation of pulsatile and static intracranial pressure by optical coherence tomography. Transl Vis Sci Technol 11:31. https://doi.org/10.1167/tvst.11.1.31CrossRefPubMedPubMedCentral

32.

Kovarik JJ, Doshi PN, Collinge JE, Plager DA (2015) Outcome of pediatric patients referred for papilledema. J AAPOS 19(4):344–348PubMedCrossRef

33.

Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD (2014) Comparison of posterior fossa decompression with or without duraplasty in children with type I Chiari malformation. Childs Nerv Syst 30:1419–1424PubMedPubMedCentralCrossRef

34.

Massimi L, Frassanito P, Chieffo D, Tamburrini G, Caldarelli M (2019) Bony decompression for Chiari malformation type I: long-term follow-up. Acta Neurochir Suppl 125:119–124PubMedCrossRef

35.

Massimi L, Pravatà E, Tamburrini G, Gaudino S, Pettorini B, Novegno F, Colosimo C Jr, Di Rocco C (2011) Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications. Neurosurgery 68:950–956PubMedCrossRef

36.

Mazerand E, Benichi S, Taverne M, Paternoster G, Rolland A, Antherieu P, Todeschi J, Kamdem Noumoye L, Gilard V, Bretonnier M, Fournier LL, Jecko V, Gimbert E, Proust F, Boetto S, Roujeau T, James S, Khonsari RH, Riffaud L, Delion M, Zerah M, Scavarda D (2022) Chiari malformation type I surgery in children: French multicenter 10-year cohort. J Neurosurg Pediatr 30:210–216PubMedCrossRef

37.

Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, Speer MC (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44:1005–1017PubMedCrossRef

38.

Mitchell A, Baig AA, Kanj U, Rodrigues D, Painter S, Abbott J (2023) Papilloedema: a highly specific predictor of raised intracranial pressure in a complex neurosurgical paediatric cohort. Childs Nerv Syst. https://doi.org/10.1007/s00381-023-06137-2CrossRefPubMedPubMedCentral

39.

Mortazavi MM, Tubbs RS, Brockerhoff MA, Loukas M, Oakes WJ (2011) The first description of Chiari I malformation with intuitive correlation between tonsillar ectopia and syringomyelia. J Neurosurg Pediatr 7:257–260PubMedCrossRef

40.

Mortazavi MM, Tubbs RS, Hankinson TC, Pugh JA, Cohen-Gadol AA, Oakes WJ (2011) The first posterior fossa decompression for Chiari malformation: the contributions of Cornelis Joachimus van Houweninge Graftdijk and a review of the infancy of “Chiari decompression”. Childs Nerv Syst 27:1851–1856PubMedCrossRef

41.

Papaker MG, Abdallah A, Cesme DH, Gönen G, Asiltürk M, Avyasov R, Sofuoğlu ÖE, Abdallah BG, Emel E (2021) Clinical and radiological evaluation of treated Chiari I adult patients: retrospective study from two neurosurgical centers. Neurosurg Rev 44:2261–2276PubMedCrossRef

42.

Poca MA, Sahuquillo J, Ibanez J, Amoros S, Arikan F, Rubio E (2002) Intracranial hypertension after surgery in patients with Chiari I malformation and normal or moderate increase in ventricular size. Acta Neurochir Suppl 81:35–38PubMed

43.

Rossi V, Wait S, Jernigan S, Van Poppel M, Pfortmiller D, Zeitouni D, Henegar MM (2021) Preoperative acetazolamide challenge in pediatric Chiari I malformation. Pediatr Neurosurg 56:328–333PubMedCrossRef

44.

Saehle T, Eide PK (2015) Characteristics of intracranial pressure (ICP) waves and ICP in children with treatment-responsive hydrocephalus. Acta Neurochir (Wien) 157:1003–1014PubMedCrossRef

45.

Saenz A, Piper RJ, Thompson D, Tahir MZ (2023) Endoscopic third ventriculostomy for the management of children with cerebrospinal fluid disorders, ventriculomegaly, and associated Chiari I malformation. World Neurosurg X 19:100200. https://doi.org/10.1016/j.wnsx.2023.100200CrossRefPubMedPubMedCentral

46.

Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO (2011) Natural history of Chiari malformation type I following decision for conservative treatment. J Neurosurg Pediatr 8:214–221PubMedCrossRef

47.

Tain RW, Bagci AM, Lam BL, Sklar EM, Ertl-Wagner B, Alperin N (2011) Determination of cranio-spinal canal compliance distribution by MRI: methodology and early application in idiopathic intracranial hypertension. J Magn Reson Imaging 34:1397–1404PubMedPubMedCentralCrossRef

48.

Thompson DNP (2019) Chiari I-a ‘not so’ congenital malformation? Childs Nerv Syst 35:1653–1664PubMedCrossRef

49.

Tubbs RS, Beckman J, Naftel RP, Chern JJ, Wellons JC 3rd, Rozzelle CJ, Blount JP, Oakes WJ (2011) Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J Neurosurg Pediatr 7:248–256PubMedCrossRef

50.

Valentini L, Visintini S, Saletti V, Chiapparini L, Estienne M, Solero CL (2011) Treatment for Chiari 1 malformation (CIM): analysis of a pediatric surgical series. Neurol Sci 32(Suppl 3):S321-324PubMedCrossRef

51.

Walker-Palmer TK, Cochrane DD, Singhal A, Steinbok P (2019) Outcomes and complications for individual neurosurgeons for the treatment of Chiari I malformation at a children’s hospital. Childs Nerv Syst 35:1895–1904PubMedCrossRef

52.

Wang B, Wang C, Zhang YW, Liang YC, Liu WH, Yang J, Xu YL, Wang YZ, Jia WQ (2023) Long-term outcomes of foramen magnum decompression with duraplasty for Chiari malformation type I in adults: a series of 297 patients. Neurosurg Focus 54:E5. https://doi.org/10.3171/2022.12.Focus22627CrossRefPubMed

53.

Wu Y, Li C, Zong X, Wang X, Gui S, Gu C, Zhang Y (2018) Application of endoscopic third ventriculostomy for treating hydrocephalus-correlated Chiari type I malformation in a single Chinese neurosurgery centre. Neurosurg Rev 41:249–254PubMedCrossRef

54.

Yarbrough CK, Greenberg JK, Smyth MD, Leonard JR, Park TS, Limbrick DD Jr (2014) External validation of the Chicago Chiari Outcome Scale. J Neurosurg Pediatr 13:679–684PubMedPubMedCentralCrossRef

55.

Yates C, Campbell R, Wood M, Chaseling R, Tollesson G, Ma N (2020) Chiari 1 malformation: age-based outcomes in a paediatric surgical cohort. Childs Nerv Syst 36:2807–2814PubMedCrossRef

Title: Preoperative estimation of intracranial compliance in symptomatic children with Chiari malformation type 1: impact on outcome and risk of complications
Authors: Radek Frič
Eline Bryne
Bogna Warsza
Bernt Johan Due-Tønnessen
Per Kristian Eide
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Intracranial Hypertension
Chiari Malformation
Chiari Malformation
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-05897-3

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Springer Medicine

Preoperative estimation of intracranial compliance in symptomatic children with Chiari malformation type 1: impact on outcome and risk of complications

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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