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01-09-2021 | Syringomyelia | Original Article

Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure?

Authors: Khashayar Mozaffari, Laurence Davidson, Eric Chalif, Tiffany N. Phan, Andrew D. Sparks, John S. Myseros, Chima O. Oluigbo, Robert F. Keating

Published in: Child's Nervous System | Issue 9/2021

Abstract

Purpose

The role of an osseous-only posterior fossa decompression (PFD) for Chiari malformation type 1 (CM1) remains controversial. We reviewed long-term outcomes for patients with CM1 undergoing a PFD to evaluate if there was any difference for failure when compared to patients undergoing a PFD with duraplasty (PFDD).

Methods

Consecutive patients surgically treated at a single tertiary pediatric neurosurgery clinic over a 25-year period with at least 5 years of follow-up were evaluated. PFD patients were compared to those that initially received a PFDD. Demographics, surgical indications, surgical approach, outcomes, and complications were reviewed.

Results

A total of 60 patients were included in this study of which 25 (41.67%) underwent PFD and 35 (58.33%) underwent PFDD. Mean age at surgery was 7.41 years (range 0.4 to 18 years) with a mean follow-up of 8.23 years (range 5 to 21 years). Those that received a PFD had a lower rate of radiographic syrinx improvement (p = 0.03), especially in the setting of holocord syringes. Failure rate was significantly higher in the PFD group (20% vs 2.90%, p = 0.03). However, complications were significantly higher in the PFDD group (17.14% vs 4.0%, p = 0.04).

Conclusions

PFD provides a safe treatment option with similar clinical improvements and lower post-operative complication rate compared to PFDD, albeit at the cost of greater chance of reoperation, especially in the setting of a holocord syrinx. Patients with a holocord syrinx should be considered for a PFDD as their initial procedure.

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Title: Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure?
Authors: Khashayar Mozaffari
Laurence Davidson
Eric Chalif
Tiffany N. Phan
Andrew D. Sparks
John S. Myseros
Chima O. Oluigbo
Robert F. Keating
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: Syringomyelia
Chiari Malformation
Chiari Malformation
Duraplasty
Headache
Published in: Child's Nervous System / Issue 9/2021
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-021-05280-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure?

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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