title: Chiari malformation: are children little adults?
abstract: OBJECTIVE
  To discuss the controversies, variability of opinion and approach, and special considerations in pediatric Chiari malformation.
  
  
  METHODS
  PubMed-based literature review with focused discussion on clinically relevant pediatric issues.
  
  
  RESULTS
  Compared to adults, children with Chiari more often present with congenital anomalies, scoliosis, and deficits in oropharyngeal control. Those with a syrinx present more with scoliosis than with deficits in sensation or pain. Surgical intervention has varied widely in its level of invasiveness though there has been a trend towards less invasive procedures with bony decompression only, especially in children where their dura may be more flexible and minimal procedures may lead to fewer complications and faster recovery.
  
  
  CONCLUSIONS
  Pediatric Chiari management must consider the effect of development, increased activity, and a longer life course on the decision to surgically treat. However, little is known about predicting the natural history of Chiari in the young. There is also difference in opinion regarding activity restriction since the number of asymptomatic children with Chiari is not known. The long-term effectiveness of less invasive procedures remains to be determined.
authors.affiliation: Department of Neurosurgery, Cleveland Clinic, OH 44195, USA. lucianm@ccf.org
authors.forename: Mark G
authors.initials: MG
authors.lastname: Luciano
mesh_terms: D000328:Adult; D000367:Age Factors; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000628:therapy*; D002648:Child; D019299:Decompression, Surgical / Q000379:methods; D002658:Developmental Disabilities / Q000150:complications*; D006801:Humans; D007223:Infant; D010372:Pediatrics; D039781:PubMed / Q000706:statistics & numerical data; D013595:Syringomyelia / Q000150:complications