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Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I.
J Neurosurg Pediatr. 2015 Aug; 16(2):150-8.JN

Abstract

OBJECT Symptomatic pediatric Chiari malformation Type I (CM-I) is most often treated with posterior fossa decompression (PFD), but controversy exists over whether the dura needs to be opened during PFD. While dural opening as a part of PFD has been suggested to result in a higher rate of resolution of CM symptoms, it has also been shown to lead to more frequent complications. In this paper, the authors present the largest reported series of outcomes after PFD without dural opening surgery, as well as identify risk factors for recurrence. METHODS The authors performed a retrospective review of 156 consecutive pediatric patients in whom the senior authors performed PFD without dural opening from 2003 to 2013. Patient demographics, clinical symptoms and signs, radiographic findings, intraoperative ultrasound results, and neuromonitoring findings were reviewed. Univariate and multivariate regression analyses were performed to determine risk factors for recurrence of symptoms and the need for reoperation. RESULTS Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up (mean 32 months). There were no major complications. The mean length of hospital stay was 2.0 days. In a multivariate regression model, partial C-2 laminectomy was an independent risk factor associated with reoperation (p = 0.037). Motor weakness on presentation was also associated with reoperation but only with trend-level significance (p = 0.075). No patient with < 8 mm of tonsillar herniation required reoperation. CONCLUSIONS The vast majority (> 90%) of children with symptomatic CM-I will have improvement or resolution of symptoms after a PFD without dural opening. A non-dural opening approach avoids major complications. While no patient with tonsillar herniation < 8 mm required reoperation, children with tonsillar herniation at or below C-2 have a higher risk for failure when this approach is used.

Authors+Show Affiliations

Department of Neurological Surgery, Columbia University, New York, New York;Department of Neurological Surgery, Columbia University, New York, New York;Department of Neurological Surgery, Columbia University, New York, New York;Department of Neurological Surgery, Columbia University, New York, New York;Department of Neurological Surgery, Pittsburgh University, Pittsburgh, Pennsylvania; and.Department of Neurological Surgery, Columbia University, New York, New York; Children's Hospital of New York, Columbia University, New York, New York.Department of Neurological Surgery, Columbia University, New York, New York; Children's Hospital of New York, Columbia University, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25932779

Citation

Kennedy, Benjamin C., et al. "Outcomes After Suboccipital Decompression Without Dural Opening in Children With Chiari Malformation Type I." Journal of Neurosurgery. Pediatrics, vol. 16, no. 2, 2015, pp. 150-8.
Kennedy BC, Kelly KM, Phan MQ, et al. Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I. J Neurosurg Pediatr. 2015;16(2):150-8.
Kennedy, B. C., Kelly, K. M., Phan, M. Q., Bruce, S. S., McDowell, M. M., Anderson, R. C., & Feldstein, N. A. (2015). Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I. Journal of Neurosurgery. Pediatrics, 16(2), 150-8. https://doi.org/10.3171/2014.12.PEDS14487
Kennedy BC, et al. Outcomes After Suboccipital Decompression Without Dural Opening in Children With Chiari Malformation Type I. J Neurosurg Pediatr. 2015;16(2):150-8. PubMed PMID: 25932779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I. AU - Kennedy,Benjamin C, AU - Kelly,Kathleen M, AU - Phan,Michelle Q, AU - Bruce,Samuel S, AU - McDowell,Michael M, AU - Anderson,Richard C E, AU - Feldstein,Neil A, Y1 - 2015/05/01/ PY - 2015/5/2/entrez PY - 2015/5/2/pubmed PY - 2015/10/23/medline KW - BAER = brainstem auditory evoked response KW - CM-I = Chiari malformation Type I KW - Chiari malformation KW - PFD = posterior fossa decompression KW - SSEP = somatosensory evoked potential KW - duraplasty KW - non–dural opening procedure KW - outcomes KW - suboccipital decompression SP - 150 EP - 8 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 16 IS - 2 N2 - OBJECT Symptomatic pediatric Chiari malformation Type I (CM-I) is most often treated with posterior fossa decompression (PFD), but controversy exists over whether the dura needs to be opened during PFD. While dural opening as a part of PFD has been suggested to result in a higher rate of resolution of CM symptoms, it has also been shown to lead to more frequent complications. In this paper, the authors present the largest reported series of outcomes after PFD without dural opening surgery, as well as identify risk factors for recurrence. METHODS The authors performed a retrospective review of 156 consecutive pediatric patients in whom the senior authors performed PFD without dural opening from 2003 to 2013. Patient demographics, clinical symptoms and signs, radiographic findings, intraoperative ultrasound results, and neuromonitoring findings were reviewed. Univariate and multivariate regression analyses were performed to determine risk factors for recurrence of symptoms and the need for reoperation. RESULTS Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up (mean 32 months). There were no major complications. The mean length of hospital stay was 2.0 days. In a multivariate regression model, partial C-2 laminectomy was an independent risk factor associated with reoperation (p = 0.037). Motor weakness on presentation was also associated with reoperation but only with trend-level significance (p = 0.075). No patient with < 8 mm of tonsillar herniation required reoperation. CONCLUSIONS The vast majority (> 90%) of children with symptomatic CM-I will have improvement or resolution of symptoms after a PFD without dural opening. A non-dural opening approach avoids major complications. While no patient with tonsillar herniation < 8 mm required reoperation, children with tonsillar herniation at or below C-2 have a higher risk for failure when this approach is used. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/25932779/Outcomes_after_suboccipital_decompression_without_dural_opening_in_children_with_Chiari_malformation_Type_I_ DB - PRIME DP - Unbound Medicine ER -