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.

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • CreveCoeur, TS; Yahanda, AT; Maher, CO; Johnson, GW; Ackerman, LL; Adelson, PD; Ahmed, R; Albert, GW; Aldana, PR; Alden, TD; Anderson, RCE; Baird, L; Bauer, DF; Bierbrauer, KS; Brockmeyer, DL; Chern, JJ; Couture, DE; Daniels, DJ; Dauser, RC; Durham, SR; Ellenbogen, RG; Eskandari, R; Fuchs, HE; George, TM; Grant, GA; Graupman, PC; Greene, S; Greenfield, JP; Gross, NL; Guillaume, DJ; Haller, G; Hankinson, TC; Heuer, GG; Iantosca, M; Iskandar, BJ; Jackson, EM; Jea, AH; Johnston, JM; Keating, RF; Kelly, MP; Khan, N; Krieger, MD; Leonard, JR; Mangano, FT; Mapstone, TB; McComb, JG; Menezes, AH; Muhlbauer, M; Oakes, WJ; Olavarria, G; O'Neill, BR; Park, TS; Ragheb, J; Selden, NR; Shah, MN; Shannon, C; Shimony, JS; Smith, J; Smyth, MD; Stone, SSD; Strahle, JM; Tamber, MS; Torner, JC; Tuite, GF; Wait, SD; Wellons, JC; Whitehead, WE; Limbrick, DD

Published Date

  • January 13, 2021

Published In

Volume / Issue

  • 88 / 2

Start / End Page

  • 332 - 341

PubMed ID

  • 33313928

Pubmed Central ID

  • PMC7803430

Electronic International Standard Serial Number (EISSN)

  • 1524-4040

Digital Object Identifier (DOI)

  • 10.1093/neuros/nyaa460


  • eng

Conference Location

  • United States