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Jackson EM, Jernigan S, Raskin JS, Ackerman LL, Infinger LK, Maher CO, Niazi T, Pattisapu JV, Qaiser R, Quinsey C, Rocque BG, Silberstein H, Vachhrajani S, Bauer DF. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Symptoms. Neurosurgery 2023; 93:727-730. [PMID: 37646519 DOI: 10.1227/neu.0000000000002634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Chiari I malformation (CIM) is characterized by descent of the cerebellar tonsils through the foramen magnum, potentially causing symptoms from compression or obstruction of the flow of cerebrospinal fluid. Diagnosis and treatment of CIM is varied, and guidelines produced through systematic review may be helpful for clinicians. OBJECTIVE To perform a systematic review of the medical literature to answer specific questions on the diagnosis and treatment of CIM. METHODS PubMed and Embase were queried between 1946 and January 23, 2021, using the search strategies provided in Appendix I of the full guidelines. RESULTS The literature search yielded 430 abstracts, of which 79 were selected for full-text review, 44 were then rejected for not meeting the inclusion criteria or for being off-topic, and 35 were included in this systematic review. CONCLUSION Four Grade C recommendations were made based on Class III evidence, and 1 question had insufficient evidence. The full guidelines can be seen online at https://www.cns.org/guidelines/browse-guidelines-detail/2-symptoms .
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Affiliation(s)
- Eric M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Sarah Jernigan
- Carolina Neurosurgery & Spine Associates, Charlotte , North Carolina , USA
| | - Jeffrey S Raskin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Laurie L Ackerman
- Department of Neurological Surgery, Indiana University Health, Indianapolis , Indiana , USA
| | - Libby Kosnik Infinger
- Department of Neurosurgery, Medical University of South Carolina (MUSC), Charleston , South Carolina , USA
| | - Cormac O Maher
- Department of Neurosurgery, Stanford Medicine, Palo Alto , California , USA
| | - Toba Niazi
- Department of Neurological Surgery, Nicklaus Children's Hospital, Miami , Florida , USA
| | - Jogi V Pattisapu
- Pediatric Neurosurgery, University of Central Florida College of Medicine, Orlando , Florida , USA
| | - Rabia Qaiser
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis , Indiana , USA
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina Chapel Hill, Chapel Hill , North Carolina , USA
| | - Brandon G Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA
| | - Howard Silberstein
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester , New York , USA
| | - Shobhan Vachhrajani
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton , Ohio , USA
| | - David F Bauer
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston , Texas , USA
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2
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Kristiansson H, Fletcher-Sandersjöö A, Cesarini K, Fransson M, Vlachogiannis P, Burström G, Hessington A, Bartek J, Edström E, Holmgren RT, Sköld MK, Elmi-Terander A. Dura Management Strategies in the Surgical Treatment of Adult Chiari Type I Malformation: A Retrospective, Multicenter, Population-Based Parallel Cohort Case Series. Oper Neurosurg (Hagerstown) 2022; 23:304-311. [PMID: 36103352 DOI: 10.1227/ons.0000000000000340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Symptomatic Chiari I malformation is treated with suboccipital decompression and C1 laminectomy. However, whether the dura should be opened (durotomy) or enlarged with a graft (duraplasty) remains unclear. OBJECTIVE To compare outcomes in adult Chiari I malformation patients treated with duraplasty, durotomy, or without dural opening ("mini-decompression"). METHODS A retrospective, multicenter, population-based cohort study was performed of all adult patients surgically treated for a Chiari I malformation at 3 regional neurosurgical centers between 2005 and 2017. Three different dura management strategies were favored by the participating hospitals, with data stratified accordingly. The primary outcome was measured using the Chicago Chiari Outcome Scale (CCOS), dichotomized into favorable (CCOS ≥13) or unfavorable (CCOS ≤12). Propensity score matching was used to adjust for potential confounders in outcome comparisons. RESULTS In total, 318 patients were included, of whom 52% were treated with duraplasty, 37% with durotomy, and 11% with mini-decompression. In total, 285 (90%) showed a favorable surgical outcome (CCOS ≥13). Duraplasty was associated with more favorable CCOS and shorter hospital stay compared with durotomy, both in unadjusted (93% vs 84%. P = .018 and 6.0 vs 8.0 days, P < .001) and adjusted analyses (92% vs 84%, P = .044 and 6.0 vs 8.0 days, P < .001). Mini-decompression was excluded from the adjusted analyses because of its small sample size. CONCLUSION In this study of adult Chiari I malformation, posterior fossa decompression with duraplasty was associated with more favorable postoperative outcome, as determined by the CCOS, compared with posterior fossa decompression with durotomy alone.
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Affiliation(s)
- Helena Kristiansson
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Cesarini
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Marcus Fransson
- Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden
| | - Pavlos Vlachogiannis
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Gustav Burström
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Amel Hessington
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rafael T Holmgren
- Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden
| | - Mattias K Sköld
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Basaran R, Bozdogan C, Senol M, Gundogan D, Isik N. Long-term outcomes of surgical management in subtypes of Chiari malformation. Neurol Res 2021; 43:760-766. [PMID: 34057045 DOI: 10.1080/01616412.2021.1934314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Chiari malformations (CMs) are a heterogeneous group of disorders defined by anatomic anomalies of the cerebellum, brainstem, and craniovertebral junction (CVJ). The aims of this study are to establish the demographic and clinical features, incidence, surgical procedures, and outcomes in large series of old and new subtypes of CMs.Material and Methods: All patients were evaluated and operated on for CM-0, 1, and 1.5 between 1985 and 2016. The patients were grouped into various subtypes. Demographic data, additional diseases, clinical features, surgical procedures, complications and outcomes were recorded.Results: 191 patients who underwent various surgical procedures were evaluated. Their mean age was 37.21 ± 9.89. We detected 15 cases of CM-0 (7.8%), 121 cases of CM-1 (63.4%), 55 cases of CM-1.5 (28.8%). In total there were 191 cases, and 220 surgical procedures were performed. 29 (13.2%) of all surgical procedure was reoperations and secondary operations. SM Cyst is found to be decreased in 72 (76.5%) patients, unchanged in 14 (14.8%) and increased in 8(8.5%) of 94 patients radiologically. Clinical outcomes are better for 131 (65.8%), same for 31 (16.2%) and worse for 9 (15%).Conclusion: This study with 172 patients is a large series that includes CM-0, 1, and 1.5 subtypes. CM-1.5 also differs for symptom presentation and durations from CM-1. There are more neurological abnormalities in patients with SM. CVD alone are an effective, useful and safe surgical procedure for CM-0, CM-1 and CM-1.5. Surgical procedure, SM existence, and symptom duration have powerful effects on outcomes.
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Affiliation(s)
- Recep Basaran
- University of Health Sciences Sancaktepe Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
| | - Caglar Bozdogan
- Medeniyet University Goztepe Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
| | - Mehmet Senol
- Medeniyet University Goztepe Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
| | - Dogan Gundogan
- Medeniyet University Goztepe Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
| | - Nejat Isik
- Medeniyet University Goztepe Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
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4
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Frič R, Eide PK. Chiari type 1-a malformation or a syndrome? A critical review. Acta Neurochir (Wien) 2020; 162:1513-1525. [PMID: 31656982 DOI: 10.1007/s00701-019-04100-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE As the understanding of pathophysiology behind Chiari malformation still is limited, the treatment of Chiari malformation type 1 remains rather empirical. This may result in suboptimal treatment strategy and outcome in many cases. In this review, we critically address whether the condition known today as Chiari malformation type I should rather be denoted Chiari syndrome. METHODS The current knowledge of Chiari malformation type 1 is summarized from the historical, etymological, genetic, clinical, and in particular pathophysiological perspectives. RESULTS There are several lines of evidence that Chiari malformation type 1 represents a condition significantly different from types 2 to 4. Unlike the other types, the type 1 should rather be considered a syndrome, thus supporting the reasons to reappraise the traditional classification of Chiari malformations. CONCLUSION We propose that Chiari malformation type 1 should rather be denoted Chiari syndrome, while the notation malformation is maintained for types 2-4.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Chiari I malformation-neuropsychological functions and quality of life. Acta Neurochir (Wien) 2020; 162:1575-1582. [PMID: 30955083 DOI: 10.1007/s00701-019-03897-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/28/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the neuropsychological (NP) functioning and quality of life (QOL) before and 3 months after surgery on adults with Chiari I malformation (CMI). PATIENTS AND METHODS All adult patients who had been diagnosed with CMI were invited to participate. Those who participated were assessed using a Hospital Anxiety and Depression scale (HAD) and NP examinations. Their QOL was assessed using the self-reported life satisfaction checklist, LiSat-11 and the five-dimensional EuroQol measurement of health outcome, EQ-5D-5L. All assessments were carried out both before and 3 months after surgery was performed. Demographic data and comorbidities were also registered. RESULTS Of the 11 patients who underwent NP assessment, the majority demonstrated cognitive functioning within the normal range. However, postoperatively, their performance in verbal learning, psychomotor speed, colour naming speed and the ability to manage interference through response selection and inhibition (aspects of executive functioning) was significantly improved. Thirteen patients completed QOL assessments. When LiSat-11 item domains were compared with those of healthy subjects, patients reported a lower level of satisfaction with their life quality both before and after surgery. However, the EQ-5D-5L measurements, i.e., the descriptive system and the visual analogue, indicated that their QOL of life was significantly improved after surgery. CONCLUSION There is scarcely any literature documenting effects of surgery on the QOL of CMI patients. The study we present here breaks new ground by comparing pre- and postoperative NP functions in CMI. We also examine the value of surgery for improving both NP functions and QOL in CMI.
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Chiari malformation type I and basilar invagination originating from atlantoaxial instability: a literature review and critical analysis. Acta Neurochir (Wien) 2020; 162:1553-1563. [PMID: 32504118 PMCID: PMC7295832 DOI: 10.1007/s00701-020-04429-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/22/2020] [Indexed: 12/27/2022]
Abstract
Introduction Recently, a novel hypothesis has been proposed concerning the origin of craniovertebral junction (CVJ) abnormalities. Commonly found in patients with these entities, atlantoaxial instability has been suspected to cause both Chiari malformation type I and basilar invagination, which renders the tried and tested surgical decompression strategy ineffective. In turn, C1-2 fusion is proposed as a single solution for all CVJ abnormalities, and a revised definition of atlantoaxial instability sees patients both with and without radiographic evidence of instability undergo fusion, instead relying on the intraoperative assessment of the atlantoaxial joints to confirm instability. Methods The authors conducted a comprehensive narrative review of literature and evidence covering this recently emerged hypothesis. The proposed pathomechanisms are discussed and contextualized with published literature. Conclusion The existing evidence is evaluated for supporting or opposing sole posterior C1-2 fusion in patients with CVJ abnormalities and compared with reported outcomes for conventional surgical strategies such as posterior fossa decompression, occipitocervical fusion, and anterior decompression. At present, there is insufficient evidence supporting the hypothesis of atlantoaxial instability being the common progenitor for CVJ abnormalities. Abolishing tried and tested surgical procedures in favor of a single universal approach would thus be unwarranted.
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De Vlieger J, Dejaegher J, Van Calenbergh F. Multidimensional, patient-reported outcome after posterior fossa decompression in 79 patients with Chiari malformation type I. Surg Neurol Int 2019; 10:242. [PMID: 31893143 PMCID: PMC6935946 DOI: 10.25259/sni_377_2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/21/2019] [Indexed: 11/09/2022] Open
Abstract
Background: We studied patient-reported outcome among patients who underwent posterior fossa decompression (PFD) for Chiari malformation type I (CM-I). Methods: We interviewed patients who underwent PFD for CM-I from 1995 to 2016. Results: A total of 79 patients were interviewed. The median age at surgery was 30 years (range 5–72 years) with 27 pediatric patients. Forty-six patients had syringomyelia (36 adults and 10 pediatric patients). Fifty-four patients (68%) reported at least some improvement, 46 (58%) important improvement, 13 (16%) worsening, and 12 stabilization (15%). Any improvement as well as important improvement were significantly more often reported in the nonsyringomyelia group (85% vs. 57%, P = 0.01 and 76% vs. 46%, P = 0.01, respectively). Of the 47 patients reporting preoperative neck pain, 31 (66%) reported at least some improvement after surgery and 9 (19%) worsening after surgery. Of the 59 patients experiencing headaches before surgery, 45 (76%) reported at least some improvement after surgery and 4 (7%) worsening. Quality of life was mostly affected by pain and discomfort in all groups. Sixty-two patients (78%) were satisfied or very satisfied with the results of surgery and 8 (11%) were unsatisfied or very unsatisfied. Up to 71 patients (90%) would consent to surgery again. Conclusion: In CM-I patients, PFD offers symptom improvement in about two-thirds of patients with high patient satisfaction. Symptom improvement is significantly higher in patients without associated syringomyelia, but patient satisfaction is similar. Symptom worsening is more frequent in the adult than in the pediatric population, with similar rates of postoperative improvement and patient satisfaction.
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Affiliation(s)
- Jan De Vlieger
- Department of Neurosurgery, University Hospitals Leuven, Herestraat, Leuven, Belgium
| | - Joost Dejaegher
- Department of Neurosurgery, University Hospitals Leuven, Herestraat, Leuven, Belgium
| | - Frank Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Herestraat, Leuven, Belgium
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Almotairi FS, Tisell M. Acute deterioration of adults with Chiari I malformation associated with extensive syrinx. Br J Neurosurg 2019; 34:13-17. [PMID: 31668085 DOI: 10.1080/02688697.2019.1684438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Chiari I malformation (CMI) is usually a chronic disorder, although it may also present as a life-threatening condition with need for urgent decompression. Studies of acute deterioration of CMI are scarce. The identification of preoperative radiological factors that predict acute deterioration in adult patients with CMI facilitates planning of early decompression and decreases CMI-related morbidity.Patients and methods: This is a retrospective study of all adult patients with CMI who were referred to Sahlgrenska University Hospital, Sweden and underwent occipitocervical decompression in the period 2006-2016. In total, 65 consecutive patients were included and data regarding the preoperative degree of tonsillar herniation and syrinx (size, length and degree of rostral extension) were registered. Acute deterioration and the need for urgent surgical decompression within 24 h of hospitalisation were noted.Results: Three patients presented with acute deterioration of symptoms (4.6%) and showed an increased length and size of syrinx and more rostral extension of syrinx as compared to non-acute patients with CMI.Conclusion: Our study highlights the incidence of acute deterioration of CMI and shows the importance of assessing preoperative size, length and rostral extension of CMI-associated syrinx as indicators of acute deterioration so that CMI patients can be assigned to early surgical decompression.
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Affiliation(s)
- Fawaz S Almotairi
- Institute of Neuroscience and Physiology, Neurosurgery Department, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
| | - Magnus Tisell
- Institute of Neuroscience and Physiology, Neurosurgery Department, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Liu Z, Hao Z, Hu S, Zhao Y, Li M. Predictive value of posterior cranial fossa morphology in the decompression of Chiari malformation type I: A retrospective observational study. Medicine (Baltimore) 2019; 98:e15533. [PMID: 31083202 PMCID: PMC6531207 DOI: 10.1097/md.0000000000015533] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Posterior fossa decompression (PFD) is the standard procedure for the treatment of Chiari malformation type I (CMI). Although most patients have satisfactory surgical outcomes, some show no improvement or even a worsening of symptoms. Patient selection is thought to account for these different surgical outcomes. Our aim was to evaluate the predictive value of the preoperative posterior cranial fossa (PCF) morphology on the efficacy of PFD.Data from 39 CMI patients with CMI-related symptoms who underwent occipital foramen enlargement + C-1 laminectomy + enlarged duraplasty were retrospectively collected from January 2011 to May 2018. The patients were divided into improved and unimproved groups according to the modified Chicago Chiari Outcome Scale. Demographic information and clinical history, including preoperative comorbidities and clinical manifestations, were recorded for the 2 groups and compared. PCF morphology was assessed based on 13 linear, 8 angular, 4 areal parameters and 4 ratios related to these liner and areal parameters. The data were then analyzed statistically.Of the 39 patients with CMI, 24 showed improvement after PFD (61.5%), whereas the remaining 15 patients showed no improvement (38.5%). The preoperative symptoms lasted 1 to 240 months, with a median of 24 months. The follow-up period ranged from 2 to 82 months, with a median of 27 months. The improved and unimproved groups differed significantly with regard to upper limb numbness (OR = 10, P = .02) and upper limb weakness (OR = 4.86, P = .02). The 2 groups did not differ significantly with regard to any morphological parameters such as tonsillar descent, syrinx size.Preoperative upper limb numbness and upper limb weakness are unfavorable factors that influence the outcome of PFD in patients with CMI. However, the morphology of PCF cannot predict the response to PFD in patients with CMI.
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Almotairi FS, Andersson M, Andersson O, Skoglund T, Tisell M. Swallowing Dysfunction in Adult Patients with Chiari I Malformation. J Neurol Surg B Skull Base 2018; 79:606-613. [PMID: 30456032 DOI: 10.1055/s-0038-1655758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/15/2018] [Indexed: 12/28/2022] Open
Abstract
Background Swallowing difficulties have been reported in patients with Chiari I malformation (CMI) with a prevalence of 4 to 47%, but existing evidence is based only on case reports. We aimed to prospectively study swallowing function in adult patients with CMI before and 3 months after surgical decompression. Methods We included all adult patients diagnosed with CMI from September 2015 to October 2017 who underwent a planned surgery at Sahlgrenska University Hospital, Sweden. The patients were offered the opportunity to participate in and undergo an assessment consisting of the "Watson Dysphagia Scale (WDS)" and "EORTC QLQ-OG25" written questionnaires in addition to videofluoroscopic examination of swallowing (VFS) before and 3 months after surgery. Demographic data and comorbidities were recorded. Results Eleven patients were included, nine of which underwent both pre- and postoperative evaluations. Four patients (36%) reported varying degrees of swallowing complaints (mean WDS score, 16). In two of these, there was substantial penetration of contrast material into the laryngeal vestibule on VFS, and in the other two patients, minor swallowing disturbances were observed. Borderline deviations from normal VFS findings were also found in three asymptomatic patients. Although not all VFS deviations completely disappeared after surgery, the patients reported no remaining symptoms. Conclusion Symptoms of dysphagia and objective abnormalities on VFS are not uncommon in CMI patients. Surgery has the potential to remedy underlying causes of dysphagia, thereby relieving its symptoms.
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Affiliation(s)
- Fawaz S Almotairi
- Department of Neurosurgery, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Andersson
- Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olof Andersson
- Department of Otorhinolaryngology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Neurosurgery, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Posturographic examination of body balance in patients with Chiari type I malformation and correlation with the presence of syringomyelia and degree of cerebellar ectopia. Turk J Phys Med Rehabil 2018; 65:74-79. [PMID: 31453546 DOI: 10.5606/tftrd.2019.2003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/10/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives We aimed to evaluate balance using the Tetrax Interactive Balance System (TIBS) in patients with Chiari type I malformation (CM-I) and to assess their fall risk with other clinical parameters. Patients and methods This cross-sectional, prospective study was conducted at physical medicine and rehabilitation outpatient clinics and neurosurgery department of a university hospital between December 2013 and December 2014. The study included a total of 36 patients (31 females, 5 males; mean age 40.6±10.0 years; range, 18 to 60 years) with CM-I. Dynamic balance was assessed using the Berg Balance Scale (BBS), and posturographic examinations were performed using the TIBS. Results The mean Fall Risk Index (FI) value was 42.4±29.8 and the mean BBS score was 55.5±1.5. The most common complaints were neck pain (94.4%), headache (88.9%), paresthesia (86.1%), fatigue (83.3%), and vertigo (80.6%). The mean tonsillar herniation below the foramen magnum was 8.7±3.8 (mm). Of the patients, 15 (42.85%) had syringomyelia. The degree of tonsillar ectopia was statistically significantly lower in patients with syringomyelia (p<0.05). The BBS scores were near identical among the patients with or without syringomyelia, although the FI values were lower in the patients with syringomyelia. Comparing cerebellar ectopia ≤9 mm versus >10 mm, the FI values were slightly higher in the patients with ectopia >10 mm, although there was no statistically significant difference in the FI or BBS values. Conclusion Our study results suggest that CM-I can decrease the body balance stability and, thus, increase the fall risk. Evaluation of balance in patients with CM using TIBS static posturography is a simple and effective technique.
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Liu W, Wu H, Aikebaier Y, Wulabieke M, Paerhati R, Yang X. No significant difference between chiari malformation type 1.5 and type I. Clin Neurol Neurosurg 2017; 157:34-39. [DOI: 10.1016/j.clineuro.2017.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/26/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022]
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13
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The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis. Neurosurg Rev 2017; 41:311-321. [DOI: 10.1007/s10143-017-0857-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/15/2017] [Accepted: 04/13/2017] [Indexed: 02/06/2023]
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14
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Frič R, Eide PK. Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension. J Neurosurg 2016; 126:1312-1322. [PMID: 27341045 DOI: 10.3171/2016.4.jns152862] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Several lines of evidence suggest common pathophysiological mechanisms in Chiari malformation Type I (CMI) and idiopathic intracranial hypertension (IIH). It has been hypothesized that tonsillar ectopy, a typical finding in CMI, is the result of elevated intracranial pressure (ICP) combined with a developmentally small posterior cranial fossa (PCF). To explore this hypothesis, the authors specifically investigated whether ICP is comparable in CMI and IIH and whether intracranial volumes (ICVs) are different in patients with CMI and IIH, which could explain the tonsillar ectopy in CMI. The authors also examined whether the symptom profile is comparable in these 2 patient groups. METHODS The authors identified all CMI and IIH patients who had undergone overnight diagnostic ICP monitoring during the period from 2002 to 2014 and reviewed their clinical records and radiological examinations. Ventricular CSF volume (VV), PCF volume (PCFV), and total ICV were calculated from initial MRI studies by using volumetric software. The static and pulsatile ICP scores during overnight monitoring were analyzed. Furthermore, the authors included a reference (REF) group consisting of patients who had undergone ICP monitoring due to suspected idiopathic normal-pressure hydrocephalus or chronic daily headache and showed normal pressure values. RESULTS Sixty-six patients with CMI and 41 with IIH were identified, with comparable demographics noted in both groups. The occurrence of some symptoms (headache, nausea, and/or vomiting) was comparable between the cohorts. Dizziness and gait ataxia were significantly more common in patients with CMI, whereas visual symptoms, diplopia, and tinnitus were significantly more frequent in patients with IIH. The cranial volume measurements (VV, PCFV, and ICV) of the CMI and IIH patients were similar. Notably, 7.3% of the IIH patients had tonsillar descent qualifying for diagnosis of CMI (that is, > 5 mm). The extent of tonsillar ectopy was significantly different between the CMI and IIH cohorts (p < 0.001) but also between these 2 cohorts and the REF group. Pulsatile ICP was elevated in both cohorts without any significant between-group differences; however, static ICP was significantly higher (p < 0.001) in the IIH group. CONCLUSIONS This study showed comparable and elevated pulsatile ICP, indicative of impaired intracranial compliance, in both CMI and IIH cohorts, while static ICP was higher in the IIH cohort. The data did not support the hypothesis that reduced PCFV combined with increased ICP causes tonsillar ectopy in CMI. Even though impaired intracranial compliance seems to be a common pathophysiological mechanism behind both conditions, the mechanisms explaining the different clinical and radiological presentations of CMI and IIH remain undefined.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet; and
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet; and.,Faculty of Medicine, University of Oslo, Norway
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Zhao JL, Li MH, Wang CL, Meng W. A Systematic Review of Chiari I Malformation: Techniques and Outcomes. World Neurosurg 2016; 88:7-14. [DOI: 10.1016/j.wneu.2015.11.087] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/25/2022]
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16
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Cerebrospinal fluid disturbance in overweight women after occipitocervical decompression in Chiari malformation type I. Acta Neurochir (Wien) 2016; 158:589-94; discussion 594. [PMID: 26743916 DOI: 10.1007/s00701-015-2678-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cerebrospinal fluid disturbance (CSFD) is a well-known complication after occipitocervical decompression (OCD) in patients with Chiari malformation type I (CMI). There is scarce data focusing on preoperative patients' factors predisposing to development of CSF disturbance. The aim of this study is to evaluate a prognostic value of some patients' factors in the prediction of CSFD after OCD in CMI patients. MATERIALS AND METHODS We undertook a 10-year (2003-2013) retrospective study of all OCD in patients with CMI performed at Sahlgrenska IC, Sahlgrenska University Hospital, Sweden. A total of 52 consecutive patients were obtained from the operation database and we excluded one patient who was previously diagnosed with normal-pressure hydrocephalus. Data regarding preoperative age, body mass index, gender, degree of tonsillar herniation and syrinx were registered. Development of CSFD after OCD was noted. RESULTS Of the 51 patients reviewed, six had CSFD after OCD and were managed using a form of CSF diversion procedure. All of the patients who developed CSFD were females. They had a mean body mass index of 32.3 compared to a mean of 24.3 in patients without CSFD (p = 0.0011). There was no difference between the two groups with regard to the other examined patient factors. CONCLUSIONS CSF diversion was needed in six consecutive adult Chiari malformation type I patients who underwent occipitocervical decompression. All patients with postoperative CSFD were female and their mean BMI was significantly higher than patients without this complication.
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17
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Frič R, Eide PK. Perioperative monitoring of pulsatile and static intracranial pressure in patients with Chiari malformation type 1 undergoing foramen magnum decompression. Acta Neurochir (Wien) 2016; 158:341-7; discussion 346-7. [PMID: 26711284 DOI: 10.1007/s00701-015-2669-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with Chiari malformation type 1 (CMI) often present with elevated pulsatile and static intracranial pressure (ICP). The preferred treatment of CMI, foramen magnum decompression (FMD), is assumed to normalise ICP and craniospinal pressure dissociation. In order to further explore the mechanisms behind FMD, the present study investigated whether or not pulsatile and static ICP normalises immediately after FMD. METHOD The study included CMI patients undergoing FMD with perioperative ICP monitoring as a part of clinical management. The pulsatile and static ICP scores were retrieved from the department's ICP database, and the clinical and radiological data from the patient records. RESULTS Eleven patients were included in the study. During the first 3 days following FMD, mixed model analysis revealed no significant time-dependent differences of preoperatively elevated either pulsatile (mean wave amplitude, MWA; p = 0.85) and/or static (mean ICP, p = 0.90) ICP. Percentage of mean ICP >15 mmHg increased during days 2 and 3 after FMD. Two patients from the present series had to receive ventriculoperitoneal shunt after FMD in the early postoperative period. CONCLUSIONS The present observations suggest that anatomical restoration of cerebrospinal fluid pathways by FMD does not lead to immediate normalisation of preoperatively altered pulsatile and static ICP in patients with CMI. This finding may explain persistent symptoms during the early period after FMD.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O.Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O.Box 4950, Nydalen, 0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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18
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Yarbrough CK, Greenberg JK, Park TS. Clinical Outcome Measures in Chiari I Malformation. Neurosurg Clin N Am 2015; 26:533-41. [PMID: 26408063 DOI: 10.1016/j.nec.2015.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chiari malformation type 1 (CM-I) is a common and often debilitating neurologic disease. Reliable evaluation of treatments has been hampered by inconsistent use of clinical outcome measures. A variety of outcome measurement tools are available, although few have been validated in CM-I. The recent development of the Chicago Chiari Outcome Scale and the Chiari Symptom Profile provides CM-I-specific instruments to measure outcomes in adults and children, although validation and refinement may be necessary.
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Affiliation(s)
- Chester K Yarbrough
- Department of Neurological Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110, USA.
| | - Jacob K Greenberg
- Department of Neurological Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110, USA
| | - Tae Sung Park
- Department of Neurological Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110, USA; Department of Neurological Surgery, St Louis Children's Hospital, Suite 4S20, St Louis, MO 63110, USA
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19
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Frič R, Eide PK. Comparison of pulsatile and static pressures within the intracranial and lumbar compartments in patients with Chiari malformation type 1: a prospective observational study. Acta Neurochir (Wien) 2015; 157:1411-23; discussion 1423. [PMID: 26105759 DOI: 10.1007/s00701-015-2465-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/01/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Chiari malformation type 1 (CMI), the obstruction of cerebrospinal fluid (CSF) flow through the foramen magnum is believed to cause alterations of intracranial pressure (ICP) pulsations. Foramen magnum decompression (FMD) is therefore considered a treatment of choice. However, the pathophysiology of CMI is poorly understood and it remains unknown how ICP alterations relate to symptoms and radiological findings. This study was undertaken to measure pulsatile pressure and its gradient between intracranial and lumbar compartments, and to determine its relationship to clinical and radiological findings. METHOD In patients with symptomatic CMI, we simultaneously measured ICP and lumbar CSF pressure, with particular focus on analysis of pulsatile pressure. Ventricular CSF volume (VV), intracranial volume (ICV) and posterior cranial fossa volume (PCFV) were calculated using volumetry software. RESULTS In 26 patients (median 35 years), we found clearly abnormal or borderline values of pulsatile ICP in 18/26 patients (69 %; median 4.5 mmHg) and abnormal pulsatile pressure gradient in 17/24 patients (71 %; median 2.6 mmHg). The correlation between pulsatile ICP and the pulsatile pressure gradient was significantly positive (p < 0.001). We found no significant correlation between pulsatile or static pressure and extent of tonsillar ectopy, VV, ICV or PCFV. The pulsatile pressure gradient was significantly higher in patients with syringomyelia (p = 0.02). CONCLUSIONS In this cohort, the pulsatile ICP was elevated in 69 %. The intracranial-lumbar pulsatile pressure gradient was abnormal in 71 % and significantly higher in patients with syringomyelia. The elevated pulsatile ICP significantly correlated with pulsatile pressure gradient; no similar correlation was found for static ICP. We interpret the results as providing evidence of impaired intracranial compliance as an important pathophysiological mechanism in CMI.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O.Box 4950, Nydalen, 0424, Oslo, Norway,
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20
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Deng X, Yang C, Gan J, Wu L, Yang T, Yang J, Xu Y. Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I. World Neurosurg 2015; 84:998-1004. [PMID: 25701768 DOI: 10.1016/j.wneu.2015.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/01/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Small-bone-window posterior fossa decompression with duraplasty is one of the popular surgical options for Chiari malformation type I, but its efficacy is controversial and the risk factors of clinical outcome remain unclear. METHODS The study cohort included 152 patients with Chiari malformation type I who received small-bone-window posterior fossa decompression at Beijing Tiantan hospital from January 2008 to September 2009. All patients underwent combined surgical procedures: a small-bone-window suboccipital decompression (diameter, 2.5-3 cm) and a C1 laminectomy (1.5- to 2-cm wide) followed by a duraplasty with an autologous graft. Clinical manifestations, radiologic features, and follow-up data during a 6-year span were analyzed. Risk factors associated with outcome were investigated by the use of χ(2) analysis and logistic regression analysis. RESULTS The average follow-up duration was 74 months. Symptoms were improved in 126 patients (82.9%), remained stable in 21 patients (13.8%), and deteriorated in 5 patients (3.3%). There was no mortality. Postoperative magnetic resonance imaging scans were available for all patients. Preoperatively, 112 patients were associated with syringomyelia, and the follow-up magnetic resonance images showed obvious reduction of syringomyelia in 73 patients (65.2%) and no significant change in 39 patients (34.8%). In addition, enlargement of the cistern magna was observed in 92 patients (85.2%). Regression analysis indicates preoperative motor dysfunction, brainstem herniation and basilar invagination may influence the clinical outcome (P < 0.05). CONCLUSIONS Small-bone-window posterior fossa decompression with duraplasty is an effective and safe treatment option with a low complication rate. Motor dysfunction, brainstem herniation, and basilar invagination are predictors of poor clinical prognosis.
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Affiliation(s)
- Xiaofeng Deng
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Chenlong Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Jiahe Gan
- School of Clinical Medicine, Capital Medical University, No. 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China
| | - Liang Wu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Jun Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050, China.
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21
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Greenberg JK, Milner E, Yarbrough CK, Lipsey K, Piccirillo JF, Smyth MD, Park TS, Limbrick DD. Outcome methods used in clinical studies of Chiari malformation Type I: a systematic review. J Neurosurg 2014; 122:262-72. [PMID: 25380104 DOI: 10.3171/2014.9.jns14406] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Chiari malformation Type I (CM-I) is a common and often debilitating neurological disease. Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes. To understand current approaches and lay a foundation for future research, the authors conducted a systematic review of the methods used in original published research articles to evaluate clinical outcomes in patients treated for CM-I. METHODS The authors searched PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov , and Cochrane databases to identify publications between January 2003 and August 2013 that met the following criteria: 1) reported clinical outcomes in patients treated for CM-I; 2) were original research articles; 3) included at least 10 patients or, if a comparative study, at least 5 patients per group; and 4) were restricted to patients with CM-I. RESULTS Among the 74 papers meeting inclusion criteria, there was wide variation in the outcome methods used. However, all approaches were broadly grouped into 3 categories: 1) "gestalt" impression of overall symptomatic improvement (n=45 papers); 2) postoperative change in specific signs or symptoms (n=20); or 3) results of various standardized assessment scales (n=22). Among standardized scales, 11 general function measures were used, compared with 6 disease-specific tools. Only 3 papers used scales validated in patients with CM-I. To facilitate a uniform comparison of these heterogeneous approaches, the authors appraised articles in multiple domains defined a priori as integral to reporting clinical outcomes in CM-I. Notably, only 7 articles incorporated patient-response instruments when reporting outcome, and only 22 articles explicitly assessed quality of life. CONCLUSIONS The methods used to evaluate clinical outcomes in CM-I are inconsistent and frequently not comparable, complicating efforts to analyze results across studies. Development, validation, and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients.
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22
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Martin VT, Neilson D. Joint Hypermobility and Headache: The Glue That Binds the Two Together - Part 2. Headache 2014; 54:1403-11. [DOI: 10.1111/head.12417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Vincent T. Martin
- Department of Internal Medicine; University of Cincinnati; Cincinnati OH USA
| | - Derek Neilson
- Department of Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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23
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Hwang GH, Kim GC, Jeong HJ, Sim YJ, Park YS. Arnold Chiari I malformation with tip-toe gait: a case report. KOREAN JOURNAL OF SPINE 2014; 10:38-40. [PMID: 24757457 PMCID: PMC3941732 DOI: 10.14245/kjs.2013.10.1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 02/23/2013] [Accepted: 03/22/2013] [Indexed: 11/19/2022]
Abstract
The Arnold-Chiari type I malformation has many symptoms such as headache, neck pain, gait impairment, abnormal movements or postures. But a few cases reported association of specific symptom including headache, neck pain, vertigo or ataxia. We report a case of 12 year-old boy presenting with tip-toe gait. Magnetic resonance imaging (MRI) study of brain and spine revealed underlying Arnold-Chiari type I malformation. This case shows that it is need for central nervous system evaluation in patients with changes of lower extremities tone.
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Affiliation(s)
- Gi Hoon Hwang
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ghi Chan Kim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Young-Joo Sim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Yong Seok Park
- Department of Neurosurgery, Kosin University College of Medicine, Busan, Korea
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24
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Hong J, Roberts DW. The Surgical Treatment of Headache. Headache 2014; 54:409-29. [DOI: 10.1111/head.12294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 12/24/2022]
Affiliation(s)
- Jennifer Hong
- Section of Neurosurgery; Dartmouth-Hitchcock Medical Center; Lebanon NH USA
| | - David W. Roberts
- Section of Neurosurgery; Dartmouth-Hitchcock Medical Center; Lebanon NH USA
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25
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Parker SL, Godil SS, Zuckerman SL, Mendenhall SK, Wells JA, Shau DN, McGirt MJ. Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults. Neurosurgery 2013; 73:569-81; discussion 581. [DOI: 10.1227/neu.0000000000000032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures.
OBJECTIVE:
To determine the effectiveness and minimum clinically important difference thresholds of SOC for the treatment of adult patients with CMI using patient-reported outcome metrics.
METHODS:
Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed up for 1 year. Baseline and 1-year postoperative pain, disability, quality of life, patient satisfaction, and return to work were assessed. Minimum clinically important difference thresholds were calculated with 2 anchors: the Health Transition Index and North American Spine Society satisfaction questionnaire.
RESULTS:
The severity of headaches improved in 37 patients (74%). Improvement in syrinx size was seen in 12 patients (63%) and myelopathy in 12 patients (60%). All patient-reported outcomes showed significant improvement 1 year postoperatively (P < .05). Of the 38 patients (76%) employed preoperatively, 29 (76%) returned to work postoperatively at a median time of 6 weeks (interquartile range, 4-12 weeks). Minimum clinically important difference thresholds after SOC for CMI were 4.4 points for numeric rating scale for headache, 0.7 points for numeric rating scale for neck pain, 13.8 percentage points for Headache Disability Index, 14.2 percentage points for Neck Disability Index, 7.0 points for Short Form-12 Physical Component Summary, 6.1 points for Short Form-12 Mental Component Summary, 4.5 points for Zung depression, 1.7 points for modified Japanese Orthopaedic Association, and 0.34 quality-adjusted life-years for Euro-Qol-5D.
CONCLUSION:
Surgical management of CMI in adults via SOC provides significant and sustained improvement in pain, disability, general health, and quality of life as assessed by patient-reported outcomes. This patient-centered assessment suggests that suboccipital decompression for CMI in adults is an effective treatment strategy.
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Affiliation(s)
- Scott L. Parker
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Saniya S. Godil
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Scott L. Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Stephen K. Mendenhall
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - John A. Wells
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - David N. Shau
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Matthew J. McGirt
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
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Abstract
The diagnosis of Chiari type I malformation (CIM) is more and more frequent in clinical practice due to the wide diffusion of magnetic resonance imaging. In many cases, such a diagnosis is made incidentally in asymptomatic patients, as including children investigated for different reasons such as mental development delay or sequelae of brain injury. The large number of affected patients, the presence of asymptomatic subjects, the uncertainties surrounding the pathogenesis of the malformation, and the different options for its surgical treatment make the management of CIM particularly controversial.This paper reports on the state of the art and the recent achievements about CIM aiming at providing further information especially on the pathogenesis, the natural history, and the management of the malformation, which are the most controversial aspects. A historial review introduces and explains the current classification. Furthermore, the main clinical, radiological, and neurophysiological findings of CIM are described to complete the picture of this heterogeneous and complex disease.
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Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
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27
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Elam MJ, Vaughn JA. Chiari type I malformations in young adults: implications for the college health practitioner. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2011; 59:757-759. [PMID: 21950258 DOI: 10.1080/07448481.2011.570400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The authors describe 2 cases of Chiari type I malformation (CM-I) in students presenting to a college health center within a 6-month period. A review of CM-I, including epidemiology, typical presentation, evaluation, and management, is followed by a discussion of the clinical and functional implications of the disorder in an emerging adult population.
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Affiliation(s)
- Mary Jane Elam
- Student Health Services, The Ohio State University, Columbus, Ohio 43210, USA.
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