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Updated: Aug 15, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Presentation and management of Chiari I malformation in children
J K Park1, P L Gleason, J R Madsen
1Department of Neurosurgery, Harvard Medical School, Children's Hospital, Boston, Mass. 02115, USA.
Insights
This study shows that surgical treatment for children with Chiari I malformation is safe and effective. Surgery significantly improved symptoms and neurological signs in all patients, with high rates of syrinx resolution.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Imaging
Background:
- Chiari I malformation is a congenital condition where brain tissue extends into the spinal canal.
- Surgical intervention aims to decompress the foramen magnum and restore cerebrospinal fluid (CSF) flow.
- Associated conditions like syringomyelia require specific surgical considerations.
Purpose of the Study:
- To evaluate the efficacy and safety of operative treatment for pediatric Chiari I malformation.
- To assess the impact of surgical decompression on symptoms and neurological signs.
- To determine the effectiveness of surgical techniques in resolving associated syringomyelia.
Main Methods:
- Retrospective review of 68 pediatric patients with Chiari I malformation.
- Surgical procedures included suboccipital craniectomy, C1 laminectomy, and dural grafting.
- Modifications included cerebellar tonsil coagulation, CSF shunting, and obex plugging in select cases.
Main Results:
- No operative mortality; low incidence of transient postoperative nausea, vomiting, and headache.
- 100% of patients reported symptom improvement and showed sign improvement within the first month.
- Sustained improvement in symptoms and neurological signs observed during follow-up (6-70 months).
- 80% syrinx resolution in patients with syringomyelia on postoperative MRI.
Conclusions:
- Standard bony and dural decompression with CSF circulation restoration is a safe and effective treatment for pediatric Chiari I malformation.
- Surgical intervention leads to significant and lasting clinical improvement.
- The surgical approach effectively addresses associated syringomyelia, improving outcomes.
Abstract:
To determine the efficacy of operative treatment for children with Chiari I malformation, the medical records and magnetic resonance imaging (MRI) studies of 68 consecutive patients cared for at The Children's Hospital, Boston, Mass., USA, from December, 1988 to November, 1996 were retrospectively reviewed. All patients underwent suboccipital craniectomy, C1 laminectomy, and dural grafting. Bipolar coagulation to shrink and reduce the volume of the cerebellar tonsils was carried out in 40 patients. In 32 of 40 patients with associated syringomyelia, the procedure included placement of a IVth ventricle to cervical subarachnoid space shunt. Twenty-three patients with syringomyelia also had plugging of the obex. There was no operative mortality. Morbidity included a 22% incidence of nausea/vomiting and a 10% incidence of headache, both limited to the immediate postoperative period. Within the first postoperative month, all patients or their parents reported clear improvement in their presenting symptoms and 93% were found to have clear improvement in their presenting signs. In follow-up periods of 6-70 months, all patients had continued unequivocal symptom improvement and all patients were found on examination to have clear improvement in neurological signs. In patients with syringomyelia, MRI studies carried out at least 6 months postoperatively revealed near total or total syrinx resolution in 80% of the cases. This study demonstrates that a standard bony and dural decompression of the foramen magnum region with modifications designed to maximize the restoration of CSF circulation across the foramen magnum is a safe, effective operative treatment for Chiari I malformation in children.
