title: Treatment practices for Chiari malformation type I with syringomyelia: results of a survey of the American Society of Pediatric Neurosurgeons.
abstract: OBJECTIVE
  The purpose of this study was to report the results of a survey of the American Society of Pediatric Neurosurgeons (ASPN) on treatment of Chiari malformation Type I (CM-I) with syringomyelia.
  
  
  METHODS
  A questionnaire was circulated during the 2006 meeting of the ASPN, in which surgeons were surveyed on their management of patients with CM-I and syringomyelia. The survey consisted of questions about 4 clinical scenarios, common causes of surgical failures, and complications.
  
  
  RESULTS
  There were 72 respondents, representing more than 90% of attendees at the 2006 ASPN meeting and approximately half of the society's members. The majority of respondents (85%) reported that they perform posterior fossa decompression as first-line treatment for CM-I with syringomyelia. Seven percent perform bony decompression alone, 36% open the dura, and 27% shrink the tonsils. Very few respondents indicated that they offer syrinx drainage as first-line therapy (< 3%). Although all respondents reported that they treat symptomatic CM-I/syringomyelia patients surgically, 15% of respondents indicated that they do not operate on asymptomatic patients. Finally, respondents stated that their most common complications are pseudomeningocele and chemical meningitis.
  
  
  CONCLUSIONS
  This survey, given to a representative group of experienced North American pediatric neurosurgeons, confirms that posterior fossa decompression is still the preferred treatment modality in children with CM-I and syringomyelia, regardless of symptoms. Although most surgeons open the dura, preferred techniques for decompression vary. In contrast to the results of past surveys, conservative follow-up is now only used by a minority of respondents and only in the asymptomatic patient, and primary syrinx drainage seems to have lost popularity. A multicenter trial of surgical outcomes has been designed based on the information from this survey.
authors: University of Wisconsin, Madison, Wisconsin, USA.
authors: Brandon G
authors: BG
authors: Rocque
authors: Timothy M
authors: TM
authors: George
authors: John
authors: J
authors: Kestle
authors: Bermans J
authors: BJ
authors: Iskandar
mesh_terms: D001139:Arnold-Chiari Malformation / Q000150:complications / Q000601:surgery*; D002648:Child; D003388:Cranial Fossa, Posterior / Q000601:surgery; D003399:Craniotomy; D004388:Dura Mater / Q000601:surgery; D005260:Female; D006261:Headache / Q000209:etiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D012600:Scoliosis / Q000150:complications; D011795:Surveys and Questionnaires; D013595:Syringomyelia / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome