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  • Chiari I Malformation: Should We Operate Pictures or Children? Proposal of a Diagnostic and Therapeutic Flow Chart Based on the Review of 450 Monoinstitutional Cases

    Final Number:
    418

    Authors:
    Laura Grazia Valentini MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: There are still many discussions about treatment for Chiari I Malformation (CM1) and Syringomyelia , both on indications and on surgical technique; Complex Chiari (CCM) are reported to need Craniovertebral Stabilization in as much ad 50%.

    Methods: The aims are to evaluate the results of CVD with/without duroplasty and/or Tonsillar resection in a large series of operated Children (150), focusing on the controversial points (association with tethered cord and craniovertebral instability) and to define the correct surgical timing by the follow-up in the series (300 asymptomatic children) about the natural history. 150 children were operated for CM at Institution. the asymptomatic children were followed by annual MRI for 4 years

    Results: In this surgical series, there were no major surgical morbidity nro mortality. Preoperative symptoms improved when related to CM1. Associated Syringomyelia reduced in >80% and disappeared in a significant number, but 30 pts needed CBL tonsils resection.An high percentage of associated Craniovertebral Junction Malformations (CVJM) was documented; these cases were defined as Complex CM (CCM) were submitted to dynamic MRI or CT: none deserved fixation; one adolescent had true instability needing fixation(0,6%)

    Conclusions: Surgery had good results on these symptoms, with an aggressive approach aimed to syrinx shrinkage. In our experience, despite the high incidence of CVJM in CM1, true clinical and MRI instability deserving CV fixation was quite rare. On the contrast, the huge population of mildly symptomatic children or CM1 occasionally diagnosed by MRI performed for other symptoms may be safely followed by annual MRI along growing, because they showed a low risk (4%) to develop symptoms or syrinx at mean time follow-up (5 years). Symptoms due to an associated syndrome (headache before all) may be wrongly attributed to CM1, leading to a surgery burdened by a clinical failure despite the anatomic success.

    Patient Care: 1.reducing the number of undue durgeries for CM1 2. tailoring the type of surgery on the subtype of CM1

    Learning Objectives: 1. to define which children need surgery 2. to define a flow chart for asymptomatic children follow up

    References:

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