TY - JOUR
T1 - Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia
T2 - Analysis of Data from the Park-Reeves Syringomyelia Research Consortium
AU - Crevecoeur, Travis S.
AU - Yahanda, Alexander T.
AU - Maher, Cormac O.
AU - Johnson, Gabrielle W.
AU - Ackerman, Laurie L.
AU - David Adelson, P. D.
AU - Ahmed, Raheel
AU - Albert, Gregory W.
AU - Aldana, Phillipp R.
AU - Alden, Tord D.
AU - Anderson, Richard C.E.
AU - Baird, Lissa
AU - Bauer, David F.
AU - Bierbrauer, Karin S.
AU - Brockmeyer, Douglas L.
AU - Chern, Joshua J.
AU - Couture, Daniel E.
AU - Daniels, David J.
AU - Dauser, Robert C.
AU - Durham, Susan R.
AU - Ellenbogen, Richard G.
AU - Eskandari, Ramin
AU - Fuchs, Herbert E.
AU - George, Timothy M.
AU - Grant, Gerald A.
AU - Graupman, Patrick C.
AU - Greene, Stephanie
AU - Greenfield, Jeffrey P.
AU - Gross, Naina L.
AU - Guillaume, Daniel J.
AU - Haller, Gabe
AU - Hankinson, Todd C.
AU - Heuer, Gregory G.
AU - Iantosca, Mark
AU - Iskandar, Bermans J.
AU - Jackson, Eric M.
AU - Jea, Andrew H.
AU - Johnston, James M.
AU - Keating, Robert F.
AU - Kelly, Michael P.
AU - Khan, Nickalus
AU - Krieger, Mark D.
AU - Leonard, Jeffrey R.
AU - Mangano, Francesco T.
AU - Mapstone, Timothy B.
AU - Gordon McComb, J.
AU - Menezes, Arnold H.
AU - Muhlbauer, Michael
AU - Jerry Oakes, W.
AU - Olavarria, Greg
AU - O'Neill, Brent R.
AU - Park, Tae Sung
AU - Ragheb, John
AU - Selden, Nathan R.
AU - Shah, Manish N.
AU - Shannon, Chevis
AU - Shimony, Joshua S.
AU - Smith, Jodi
AU - Smyth, Matthew D.
AU - Stone, Scellig S.D.
AU - Strahle, Jennifer M.
AU - Tamber, Mandeep S.
AU - Torner, James C.
AU - Tuite, Gerald F.
AU - Wait, Scott D.
AU - Wellons, John C.
AU - Whitehead, William E.
AU - Limbrick, David D.
N1 - Publisher Copyright:
Copyright © 2020 by the Congress of Neurological Surgeons.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - 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.
AB - 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.
KW - Chiari malformation
KW - Clivo-axial angle
KW - Craniovertebral junction
KW - Occipital-cervical fusion
KW - Syringomyelia
KW - Ventral brainstem compression
KW - pB-C2
UR - http://www.scopus.com/inward/record.url?scp=85100069421&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyaa460
DO - 10.1093/neuros/nyaa460
M3 - Article
C2 - 33313928
AN - SCOPUS:85100069421
SN - 0148-396X
VL - 88
SP - 332
EP - 341
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -