Chiari malformation: are children little adults?

OBJECTIVES

To discuss the controversies, variability of opinion and approach, and special considerations in pediatric Chiari malformation.

METHODS

PubMed-based literature review with focused discussion on clinically relevant pediatric issues.

RESULTS

Compared to adults, children with Chiari more often present with congenital anomalies, scoliosis, and deficits in oropharyngeal control. Those with a syrinx present more with scoliosis than with deficits in sensation or pain. Surgical intervention has varied widely in its level of invasiveness though there has been a trend towards less invasive procedures with bony decompression only, especially in children where their dura may be more flexible and minimal procedures may lead to fewer complications and faster recovery.

CONCLUSIONS

Pediatric Chiari management must consider the effect of development, increased activity, and a longer life course on the decision to surgically treat. However, little is known about predicting the natural history of Chiari in the young. There is also difference in opinion regarding activity restriction since the number of asymptomatic children with Chiari is not known. The long-term effectiveness of less invasive procedures remains to be determined.