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Surgical Experience in Pediatric Patients with Chiari-I Malformations Aged ≤18 Years
Ghanshyam Das Singhal1, Shakti Singhal2, Gunjan Agrawal3
1Department of Neurosurgery, JIPMER, New Delhi, India.
Insights
Surgical treatment for pediatric Chiari I malformation effectively improved neurological symptoms, including pain and ataxia. Foramen magnum decompression with lax duroplasty is recommended to halt disease progression in children.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Science
Background:
- Chiari I malformation is a congenital condition affecting the cerebellum.
- Surgical intervention is often necessary for symptomatic pediatric patients.
- Understanding surgical outcomes is crucial for treatment planning.
Purpose of the Study:
- To evaluate the surgical outcomes in pediatric patients with Chiari I malformation.
- To assess the effectiveness of foramen magnum decompression with lax duroplasty.
- To identify factors influencing neurological deficit progression.
Main Methods:
- Retrospective study of pediatric patients (<18 years) surgically treated for Chiari I malformation.
- Analysis of symptom improvement post-surgery, including pain, ataxia, and neurological deficits.
- Review of magnetic resonance imaging (MRI) findings, particularly syrinx resolution.
Main Results:
- Surgical treatment showed significant improvement in headache, neck/back pain (69.56%), upper-extremity symptoms (73.91%), ataxia (66.66%), and lower-limb deficits (83.33%).
- Oropharyngeal symptoms improved in 33% of patients.
- Syrinx resolution or diminution was observed in 66.33% of patients with available MRI data.
Conclusions:
- Foramen magnum decompression with lax duroplasty is an effective surgical procedure for pediatric Chiari I malformation.
- Surgery helps to arrest the progression of neurological deficits in affected children.
- The procedure demonstrates positive outcomes in alleviating various symptoms associated with the condition.
Objective:
The objective of this study was to retrospectively study Chiari I malformation patients (<18 years) treated surgically.
Materials And Methods:
Chiari I malformation patients (<18 years) treated surgically at our institute were retrospectively studied.
Results:
During the study period between January 1999 and June 2011, fifty patients, aged ≤18 years with Chiari malformation, were treated surgically and formed the basis for this series. There were 21 female children (42%) and 29 male children (58%), with a female-to-male ratio of 1:1. At the last follow-up, oropharyngeal symptoms were improved in 33% (n = 3/9). Headache/neck/back pain improved in 69.56% of children (n = 16/23). Upper-extremity pain/weakness/numbness improved in 73.91% of children (n = 17/23). Ataxia improved in 66.66% of children (n = 4/6). Lower-limb weakness/hyperreflexia improved in 83.33% of children (n = 5/6). At follow-up, magnetic resonance imaging for patients with syrinx was available for 75% of patients (n = 30/50) and not available for 25% of patients (n = 10/40). Syrinx was diminished in size or resolved in 66.33% of patients (n = 19/30) and the remaining was same for 36.66% of patients (n = 11/30).
Conclusions:
The main goal of surgery is to arrest the progression of neurological deficits. Foramen magnum decompression with a lax duroplasty is the surgical procedure of choice.
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