Journal article
Surgical management of symptomatic Chiari II malformation in infants and children
Child's nervous system, v 29(7), pp 1143-1154
01 Jul 2013
PMID: 23388856
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Variation exists in the surgical methods employed for decompression of Chiari II malformation (CIIM), yet an evaluation of these techniques has not been performed. The purpose of this study was to assess the efficacy of bony decompression (cervical laminectomy alone versus suboccipital craniectomy with laminectomy) with or without dural augmentation for the treatment of symptomatic CIIM.
Clinical records of children 0-18 years of age who underwent surgical repair of myelomeningocele or CIIM decompression at St. Louis Children's Hospital (SLCH) from 1990-2011 were reviewed. Signs/symptoms prompting decompression, surgical technique, operative parameters, and clinical outcomes were recorded for analysis.
Thirty-three subjects were treated at SLCH for CIIM decompression. Twenty-six subjects underwent bony decompression only (21 cervical laminectomy alone, 5 suboccipital craniectomy + cervical laminectomy) while seven underwent bony decompression with upfront dural augmentation (three cervical laminectomy alone, four suboccipital craniectomy + cervical laminectomy). Median follow up was 5.0 years (range, 3 months-19 years). Symptomatic improvement was noted in 20/33 subjects (60.6%). Sixty-two (61.5%) percent of children who underwent bony decompression had symptomatic improvement, compared with 57.1% of those with upfront dural augmentation (p = 0.37). Estimated blood loss, operative time, and length of perioperative hospital stay appeared lower in the bony decompression group but were not statistically different in this limited cohort.
The results from this series suggest that bony CIIM decompression via tailored cervical laminectomies alone, without suboccipital craniectomy or upfront dural augmentation, is a reasonable initial management approach for decompression of symptomatic CIIM.
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Details
- Title
- Surgical management of symptomatic Chiari II malformation in infants and children
- Creators
- S Hassan A Akbari - St. Louis Children's HospitalDavid D Limbrick, Jr - Washington University in St. LouisDavid H Kim - St. Louis Children's HospitalPrithvi Narayan - St. Christopher's Hospital for ChildrenJeffrey R Leonard - St. Louis Children's HospitalMatthew D Smyth - Washington University in St. LouisTae Sung Park - St. Louis Children's Hospital
- Publication Details
- Child's nervous system, v 29(7), pp 1143-1154
- Publisher
- Springer Nature
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics; Neurosurgery
- Web of Science ID
- WOS:000320374800014
- Scopus ID
- 2-s2.0-84879222570
- Other Identifier
- 991021955154104721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Pediatrics
- Surgery