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The Seow Operative Score (SOS) as a decision-making adjunct for paediatric Chiari I malformation: a preliminary study

Sharon Y Y Low1,2,3, Lee Ping Ng4, Audrey J L Tan4

  • 1Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. sharon.low.y.y@singhealth.com.sg.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|June 9, 2019
PubMed

Insights

The natural history of Chiari I malformation (C1M) in children is unclear. This study introduces the Seow Operative Score (SOS) to aid in managing paediatric C1M, showing its utility in guiding surgical decisions.

Area of Science:

  • Neurosurgery
  • Paediatric Neurology
  • Medical Scoring Systems

Background:

  • The natural history and management of Chiari I malformation (C1M) in children remain poorly understood.
  • Conflicting reports exist regarding surgical indications, techniques, and prognostic indicators for paediatric C1M.

Purpose of the Study:

  • To report institutional experience in managing paediatric Chiari I malformation (C1M).
  • To discuss workflow processes including imaging, surgical techniques, and intervention indications.
  • To introduce and evaluate the Seow Operative Score (SOS) for feasibility in neurosurgical intervention for paediatric C1M.

Main Methods:

  • Retrospective review of paediatric C1M patients, divided into non-operated (10) and operated (19) groups.
  • Application of the in-house designed Seow Operative Score (SOS) to stratify patients.
  • Analysis of patient outcomes based on SOS and treatment decisions.

Main Results:

  • Non-operated patients predominantly had a low SOS (0-1), with one patient (SOS 2.5) showing resolution of symptoms and syrinx under surveillance.
  • Operated patients mostly had a high SOS (≥3).
  • Two patients with SOS 2 underwent surgery due to progressive symptoms or extensive syrinx after surveillance.

Conclusions:

  • The Seow Operative Score (SOS) demonstrates feasibility in guiding neurosurgical intervention decisions for paediatric Chiari I malformation (C1M).
  • Institutional experience highlights the importance of tailored management based on individual patient factors and scoring systems.
  • Further global research is advocated for enhanced understanding and management of paediatric C1M.
Abstract

Keywords:
Chiari I malformationSuboccipital decompression

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