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Presentation and management of Chiari I malformation in children.
Pediatr Neurosurg. 1997 Apr; 26(4):190-6.PN

Abstract

To determine the efficacy of operative treatment for children with Chiari I malformation, the medical records and magnetic resonance imaging (MRI) studies of 68 consecutive patients cared for at The Children's Hospital, Boston, Mass., USA, from December, 1988 to November, 1996 were retrospectively reviewed. All patients underwent suboccipital craniectomy, C1 laminectomy, and dural grafting. Bipolar coagulation to shrink and reduce the volume of the cerebellar tonsils was carried out in 40 patients. In 32 of 40 patients with associated syringomyelia, the procedure included placement of a IVth ventricle to cervical subarachnoid space shunt. Twenty-three patients with syringomyelia also had plugging of the obex. There was no operative mortality. Morbidity included a 22% incidence of nausea/vomiting and a 10% incidence of headache, both limited to the immediate postoperative period. Within the first postoperative month, all patients or their parents reported clear improvement in their presenting symptoms and 93% were found to have clear improvement in their presenting signs. In follow-up periods of 6-70 months, all patients had continued unequivocal symptom improvement and all patients were found on examination to have clear improvement in neurological signs. In patients with syringomyelia, MRI studies carried out at least 6 months postoperatively revealed near total or total syrinx resolution in 80% of the cases. This study demonstrates that a standard bony and dural decompression of the foramen magnum region with modifications designed to maximize the restoration of CSF circulation across the foramen magnum is a safe, effective operative treatment for Chiari I malformation in children.

Authors+Show Affiliations

Department of Neurosurgery, Harvard Medical School, Children's Hospital, Boston, Mass. 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9436829

Citation

Park, J K., et al. "Presentation and Management of Chiari I Malformation in Children." Pediatric Neurosurgery, vol. 26, no. 4, 1997, pp. 190-6.
Park JK, Gleason PL, Madsen JR, et al. Presentation and management of Chiari I malformation in children. Pediatr Neurosurg. 1997;26(4):190-6.
Park, J. K., Gleason, P. L., Madsen, J. R., Goumnerova, L. C., & Scott, R. M. (1997). Presentation and management of Chiari I malformation in children. Pediatric Neurosurgery, 26(4), 190-6.
Park JK, et al. Presentation and Management of Chiari I Malformation in Children. Pediatr Neurosurg. 1997;26(4):190-6. PubMed PMID: 9436829.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Presentation and management of Chiari I malformation in children. AU - Park,J K, AU - Gleason,P L, AU - Madsen,J R, AU - Goumnerova,L C, AU - Scott,R M, PY - 1997/4/1/pubmed PY - 1998/1/22/medline PY - 1997/4/1/entrez SP - 190 EP - 6 JF - Pediatric neurosurgery JO - Pediatr Neurosurg VL - 26 IS - 4 N2 - To determine the efficacy of operative treatment for children with Chiari I malformation, the medical records and magnetic resonance imaging (MRI) studies of 68 consecutive patients cared for at The Children's Hospital, Boston, Mass., USA, from December, 1988 to November, 1996 were retrospectively reviewed. All patients underwent suboccipital craniectomy, C1 laminectomy, and dural grafting. Bipolar coagulation to shrink and reduce the volume of the cerebellar tonsils was carried out in 40 patients. In 32 of 40 patients with associated syringomyelia, the procedure included placement of a IVth ventricle to cervical subarachnoid space shunt. Twenty-three patients with syringomyelia also had plugging of the obex. There was no operative mortality. Morbidity included a 22% incidence of nausea/vomiting and a 10% incidence of headache, both limited to the immediate postoperative period. Within the first postoperative month, all patients or their parents reported clear improvement in their presenting symptoms and 93% were found to have clear improvement in their presenting signs. In follow-up periods of 6-70 months, all patients had continued unequivocal symptom improvement and all patients were found on examination to have clear improvement in neurological signs. In patients with syringomyelia, MRI studies carried out at least 6 months postoperatively revealed near total or total syrinx resolution in 80% of the cases. This study demonstrates that a standard bony and dural decompression of the foramen magnum region with modifications designed to maximize the restoration of CSF circulation across the foramen magnum is a safe, effective operative treatment for Chiari I malformation in children. SN - 1016-2291 UR - https://www.unboundmedicine.com/medline/citation/9436829/Presentation_and_management_of_Chiari_I_malformation_in_children_ L2 - https://www.karger.com?DOI=10.1159/000121190 DB - PRIME DP - Unbound Medicine ER -