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Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data From the Park-Reeves Syringomyelia Research Consortium. Neurosurgery CreveCoeur, T. S., Yahanda, A. T., Maher, C. O., Johnson, G. W., Ackerman, L. L., Adelson, P. D., Ahmed, R., Albert, G. W., Aldana, P. R., Alden, T. D., Anderson, R. C., Baird, L., Bauer, D. F., Bierbrauer, K. S., Brockmeyer, D. L., Chern, J. J., Couture, D. E., Daniels, D. J., Dauser, R. C., Durham, S. R., Ellenbogen, R. G., Eskandari, R., Fuchs, H. E., George, T. M., Grant, G. A., Graupman, P. C., Greene, S., Greenfield, J. P., Gross, N. L., Guillaume, D. J., Haller, G., Hankinson, T. C., Heuer, G. G., Iantosca, M., Iskandar, B. J., Jackson, E. M., Jea, A. H., Johnston, J. M., Keating, R. F., Kelly, M. P., Khan, N., Krieger, M. D., Leonard, J. R., Mangano, F. T., Mapstone, T. B., McComb, J. G., Menezes, A. H., Muhlbauer, M., Oakes, W. J., Olavarria, G., O'Neill, B. R., Park, T. S., Ragheb, J., Selden, N. R., Shah, M. N., Shannon, C., Shimony, J. S., Smith, J., Smyth, M. D., Stone, S. S., Strahle, J. M., Tamber, M. S., Torner, J. C., Tuite, G. F., Wait, S. D., Wellons, J. C., Whitehead, W. E., Limbrick, D. D. 2020

Abstract

BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology.OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD.METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia=5mm, syrinx diameter=3mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD+OCF or PFD+OCF/VD.RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD+OCF), whereas 4 had OCF and VD (PFD+OCF/VD). Of those with complete data, a history of platybasia (3/10, P=.011), Klippel-Feil (2/10, P=.015), and basilar invagination (3/12, P<.001) were increased within the OCF group, whereas only basilar invagination (1/4, P<.001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8± 15.3°, P=.008) and OCF/VD (115.0± 11.6°, P=.025) groups when compared to PFD-only group (145.3± 12.7°). pB-C2 did not differ among groups.CONCLUSION: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.

View details for DOI 10.1093/neuros/nyaa460

View details for PubMedID 33313928