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Surgical management of symptomatic Chiari II malformation in infants and children.
Childs Nerv Syst. 2013 Jul; 29(7):1143-54.CN

Abstract

PURPOSE

Variation exists in the surgical methods employed for decompression of Chiari II malformation (CIIM), yet an evaluation of these techniques has not been performed. The purpose of this study was to assess the efficacy of bony decompression (cervical laminectomy alone versus suboccipital craniectomy with laminectomy) with or without dural augmentation for the treatment of symptomatic CIIM.

METHODS

Clinical records of children 0-18 years of age who underwent surgical repair of myelomeningocele or CIIM decompression at St. Louis Children's Hospital (SLCH) from 1990-2011 were reviewed. Signs/symptoms prompting decompression, surgical technique, operative parameters, and clinical outcomes were recorded for analysis.

RESULTS

Thirty-three subjects were treated at SLCH for CIIM decompression. Twenty-six subjects underwent bony decompression only (21 cervical laminectomy alone, 5 suboccipital craniectomy + cervical laminectomy) while seven underwent bony decompression with upfront dural augmentation (three cervical laminectomy alone, four suboccipital craniectomy + cervical laminectomy). Median follow up was 5.0 years (range, 3 months-19 years). Symptomatic improvement was noted in 20/33 subjects (60.6%). Sixty-two (61.5%) percent of children who underwent bony decompression had symptomatic improvement, compared with 57.1% of those with upfront dural augmentation (p = 0.37). Estimated blood loss, operative time, and length of perioperative hospital stay appeared lower in the bony decompression group but were not statistically different in this limited cohort.

CONCLUSIONS

The results from this series suggest that bony CIIM decompression via tailored cervical laminectomies alone, without suboccipital craniectomy or upfront dural augmentation, is a reasonable initial management approach for decompression of symptomatic CIIM.

Authors+Show Affiliations

Departments of Neurosurgery and St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO, 63110-1077, USA. akbaris@wudosis.wustl.edu.Departments of Neurosurgery and St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO, 63110-1077, USA. Departments of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.Departments of Neurosurgery and St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO, 63110-1077, USA.Department of Neurological Surgery, St. Christopher's Hospital, Philadelphia, PA, USA.Departments of Neurosurgery and St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO, 63110-1077, USA. Departments of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.Departments of Neurosurgery and St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO, 63110-1077, USA. Departments of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.Departments of Neurosurgery and St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO, 63110-1077, USA. Departments of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23388856

Citation

Akbari, S Hassan A., et al. "Surgical Management of Symptomatic Chiari II Malformation in Infants and Children." Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, vol. 29, no. 7, 2013, pp. 1143-54.
Akbari SH, Limbrick DD, Kim DH, et al. Surgical management of symptomatic Chiari II malformation in infants and children. Childs Nerv Syst. 2013;29(7):1143-54.
Akbari, S. H., Limbrick, D. D., Kim, D. H., Narayan, P., Leonard, J. R., Smyth, M. D., & Park, T. S. (2013). Surgical management of symptomatic Chiari II malformation in infants and children. Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 29(7), 1143-54. https://doi.org/10.1007/s00381-013-2040-9
Akbari SH, et al. Surgical Management of Symptomatic Chiari II Malformation in Infants and Children. Childs Nerv Syst. 2013;29(7):1143-54. PubMed PMID: 23388856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of symptomatic Chiari II malformation in infants and children. AU - Akbari,S Hassan A, AU - Limbrick,David D,Jr AU - Kim,David H, AU - Narayan,Prithvi, AU - Leonard,Jeffrey R, AU - Smyth,Matthew D, AU - Park,Tae Sung, Y1 - 2013/02/07/ PY - 2012/10/01/received PY - 2013/01/25/accepted PY - 2013/2/8/entrez PY - 2013/2/8/pubmed PY - 2016/12/15/medline KW - Brainstem compression KW - Chiari type II malformation KW - Decompression KW - Dural augmentation KW - Myelomeningocele KW - Syrinx SP - 1143 EP - 54 JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery JO - Childs Nerv Syst VL - 29 IS - 7 N2 - PURPOSE: Variation exists in the surgical methods employed for decompression of Chiari II malformation (CIIM), yet an evaluation of these techniques has not been performed. The purpose of this study was to assess the efficacy of bony decompression (cervical laminectomy alone versus suboccipital craniectomy with laminectomy) with or without dural augmentation for the treatment of symptomatic CIIM. METHODS: Clinical records of children 0-18 years of age who underwent surgical repair of myelomeningocele or CIIM decompression at St. Louis Children's Hospital (SLCH) from 1990-2011 were reviewed. Signs/symptoms prompting decompression, surgical technique, operative parameters, and clinical outcomes were recorded for analysis. RESULTS: Thirty-three subjects were treated at SLCH for CIIM decompression. Twenty-six subjects underwent bony decompression only (21 cervical laminectomy alone, 5 suboccipital craniectomy + cervical laminectomy) while seven underwent bony decompression with upfront dural augmentation (three cervical laminectomy alone, four suboccipital craniectomy + cervical laminectomy). Median follow up was 5.0 years (range, 3 months-19 years). Symptomatic improvement was noted in 20/33 subjects (60.6%). Sixty-two (61.5%) percent of children who underwent bony decompression had symptomatic improvement, compared with 57.1% of those with upfront dural augmentation (p = 0.37). Estimated blood loss, operative time, and length of perioperative hospital stay appeared lower in the bony decompression group but were not statistically different in this limited cohort. CONCLUSIONS: The results from this series suggest that bony CIIM decompression via tailored cervical laminectomies alone, without suboccipital craniectomy or upfront dural augmentation, is a reasonable initial management approach for decompression of symptomatic CIIM. SN - 1433-0350 UR - https://www.unboundmedicine.com/medline/citation/23388856/Surgical_management_of_symptomatic_Chiari_II_malformation_in_infants_and_children_ L2 - https://doi.org/10.1007/s00381-013-2040-9 DB - PRIME DP - Unbound Medicine ER -