Relevance of surgical strategies for the management of pediatric Chiari type I malformation.
OBJECTIVE
In face of continuing controversy to the optimal treatment of Chiari type I malformation, the authors analyzed three different surgical strategies.


METHODS
Sixty patients (30 boys and 30 girls, mean age 8.2 years) presented with clinical Chiari malformation. Additional syringomyelia was present in 24 children, whereas cine flow studies showed no flow in the craniocervical junction in 48 children. All patients underwent a limited occipital craniectomy; a duraplasty was performed in 21 cases; and additional tonsillar reduction was performed in 19 cases. Clinical improvement was seen in 24 patients who underwent posterior decompression with or without duraplasty. In the tonsillar group, clinical improvement was evident in 18 patients.


CONCLUSIONS
Duraplasty and tonsillar reduction were equally effective but significantly better than bone decompression alone. Among patients with syringomyelia, tonsillar reduction was associated with a significantly better outcome. Postoperative flow studies improved in 39 patients but did not correlate to the clinical outcome.
Galarza
Marcelo
M
Department of Neurosurgery, Children's Hospital of Turin, Turin, Italy.
Sood
Sandeep
S
Ham
Steven
S
D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000601:surgery*; D002531:Cerebellum / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D004388:Dura Mater / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013595:Syringomyelia / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome