Management of Chiari I malformation in children: personal opinions.
Childs Nerv Syst
; 35(10): 1921-1923, 2019 10.
Article
en En
| MEDLINE
| ID: mdl-31053998
ABSTRACT
PURPOSE:
This manuscript describes our management philosophy of Chiari I malformation in children based on a single neurosurgeon's personal experience.METHODS:
Based on 61 infants and children with Chiari I malformation treated from 2007 to 2017, typical symptoms, surgical indications, types of surgery, and evaluation of surgical decompression are reviewed.RESULTS:
Sixty-one patients had 69 decompressions, with 90% having symptom improvement. Seven (11.5%) needed reoperation, 1 of which needed 2 reoperations for recurrence. The recurrence rates were 20% (5 of 25) after dural scoring and 5.6% (2 of 36) after duraplasty (p = 0.1116, Fisher's exact test). Six (16%) of 36 patients developed pseudomeningocele or CSF leak.CONCLUSIONS:
We recommend surgical intervention for Chiari I malformation for clearly symptomatic patients and those with significant hydromyelia regardless of symptoms. A bony decompression with dural scoring is recommended for patients with typical occipital headaches with a lesser degree of tonsillar descent, while an expansile duraplasty is standard for those with high-grade tonsillar descent, medullary kink, or hydromyelia. Intraoperative ultrasound is often helpful to ensure the adequacy of the decompression. Most patients will have improvements in symptom and imaging after either type of decompressive surgery.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Malformación de Arnold-Chiari
/
Descompresión Quirúrgica
/
Manejo de la Enfermedad
/
Toma de Decisiones Clínicas
Tipo de estudio:
Prognostic_studies
Límite:
Child
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Childs Nerv Syst
Asunto de la revista:
NEUROLOGIA
/
PEDIATRIA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Estados Unidos