Journal of neurosurgery. Pediatrics · 2026
A retrospective single-center series on the surgical management and postoperative outcomes of pediatric Chiari malformation type I. Part 2: symptomatic outcomes and revision surgery.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Nturibi Eric M, Piazza Martin G, Kim Song L, Zhang Xiaoran, Katz Joel S, Pollack Ian F, Greene Stephanie
Аннотация
OBJECTIVE: Chiari decompression is the definitive treatment for symptomatic Chiari malformation type I (CM-I). In part 1 of this two-part series, operative management and perioperative complications were discussed. Presented here are the symptomatic outcomes from a large cohort of pediatric patients who underwent Chiari decompression.
METHODS: A departmental operative database was queried for patients who underwent Chiari decompression between 1992 and 2021; 510 patients were identified. Data regarding patient outcomes were collected.
RESULTS: Seventy-three percent of patients with exertional suboccipital headaches and 67% of patients with central sleep apnea reported improvement, while 77% of patients with syringomyelia and postoperative imaging exhibited a reduction in the length or diameter of the syrinx after decompressive surgery. Among the 32 patients with syringomyelia as an indication for repeat surgery, 18 (56%) had structural causes of syrinx formation or persistence identified on preoperative imaging and all had structural causes identified intraoperatively. Postoperative complications requiring readmission after revision surgery occurred in 18% of patients, slightly higher than with primary Chiari decompression (11%), although the most common complications remained CSF leakage and aseptic meningitis. Nine percent of patients required repeat decompression due to worsening or new Chiari symptoms or persistent syringomyelia, with a median time to repeat surgery of 17 months.
CONCLUSIONS: The authors present an institutional experience with Chiari decompression. Both initial and revision decompressive surgeries were predominantly performed as posterior fossa decompression with duraplasty and tonsillopexy and demonstrated high rates of postoperative symptomatic and radiographic improvement. Revision surgery was necessary in < 10% of patients, most commonly due to syrinx persistence or formation secondary to intradural scarring from the initial surgery.
METHODS: A departmental operative database was queried for patients who underwent Chiari decompression between 1992 and 2021; 510 patients were identified. Data regarding patient outcomes were collected.
RESULTS: Seventy-three percent of patients with exertional suboccipital headaches and 67% of patients with central sleep apnea reported improvement, while 77% of patients with syringomyelia and postoperative imaging exhibited a reduction in the length or diameter of the syrinx after decompressive surgery. Among the 32 patients with syringomyelia as an indication for repeat surgery, 18 (56%) had structural causes of syrinx formation or persistence identified on preoperative imaging and all had structural causes identified intraoperatively. Postoperative complications requiring readmission after revision surgery occurred in 18% of patients, slightly higher than with primary Chiari decompression (11%), although the most common complications remained CSF leakage and aseptic meningitis. Nine percent of patients required repeat decompression due to worsening or new Chiari symptoms or persistent syringomyelia, with a median time to repeat surgery of 17 months.
CONCLUSIONS: The authors present an institutional experience with Chiari decompression. Both initial and revision decompressive surgeries were predominantly performed as posterior fossa decompression with duraplasty and tonsillopexy and demonstrated high rates of postoperative symptomatic and radiographic improvement. Revision surgery was necessary in < 10% of patients, most commonly due to syrinx persistence or formation secondary to intradural scarring from the initial surgery.