Citations 1
Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data From the Park-Reeves Syringomyelia Research Consortium
CreveCoeur, Travis S. , Yahanda, Alexander T. , Maher, Cormac O. , Johnson, Gabrielle W. , Ackerman, Laurie L. , Adelson, P. David , Albert, Gregory W. , Aldana, Phillipp R, Alden, Tord D. , Anderson, Richard C. E. , Baird, Lissa , Bauer, David F. , Bierbrauer, Karin S. , Brockmeyer, Douglas L. , Chern, Joshua J. , Couture, Daniel E., Daniels, David, Dauser, Robert C., Durham, Susan, Ellenbogen, Richard G. , Eskandari, Ramin , Fuchs, Herbert E., George, Timothy M., Greene, Stephanie , Gross, Naina L. , Guillaume, Daniel, Hankinson, Todd C. , Heuer, Gregory G. , Iantosca, Mark, Iskandar, Bermans J. , Jackson, Eric M. , Jea, Andrew, Johnston, James M. , Keating, Robert F., Kelly, Michael P. , Khan, Nickalus R. , Krieger, Mark D., Leonard, Jeffrey R. , Mangano, Francesco T. , Mapstone, Timothy B., McComb, J. Gordon , Muhlbauer, Michael S., Oakes, W. Jerry, Olavarria, Greg, O’Neill, Brent R., Park, Tae Sung, Ragheb, John , Shannon, Chevis N. , Smith, Jodi L. , Stone, Scellig , Strahle, Jennifer M. , Tamber, Mandeep S. , Torner, James C., Tuite, Gerald F. , Wait, Scott D. , Wellons, John C. , Whitehead, William E. , Limbrick, David D. , Torner, James C. , Kelly, Michael P , Yahanda, Alexander T , Ahmed, Raheel , Aldana, Phillip R., Grant, Gerald A. , Graupman, Patrick C. , Greenfield, Jeffrey P. , Guillaume, Daniel J, Haller, Gabe , Menezes, Arnold H. , Selden, Nathan R. W. , Shah, Manish N. , Shimony, Joshua S. , Limbrick, David D.
Neurosurgery | September 22, 2020 | Volume: 88 | Issue: 2 | Pages: 332-341
Abstract BACKGROUND Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P < .001) were increased within the OCF group, whereas only basilar invagination (1/4, P < .001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P = .008) and OCF/VD (115.0 ± 11.6°, P = .025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. CONCLUSION Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.