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Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study.

Publication ,  Journal Article
Koueik, J; Sandoval-Garcia, C; Kestle, JRW; Rocque, BG; Frim, DM; Grant, GA; Keating, RF; Muh, CR; Oakes, WJ; Pollack, IF; Selden, NR; Warf, B ...
Published in: J Neurosurg Pediatr
January 1, 2020

OBJECTIVE: Despite significant advances in diagnostic and surgical techniques, the surgical management of Chiari malformation type I (CM-I) with associated syringomyelia remains controversial, and the type of surgery performed is surgeon dependent. This study's goal was to determine the feasibility of a prospective, multicenter, cohort study for CM-I/syringomyelia patients and to provide pilot data that compare posterior fossa decompression and duraplasty (PFDD) with and without tonsillar reduction. METHODS: Participating centers prospectively enrolled children suffering from both CM-I and syringomyelia who were scheduled to undergo surgical decompression. Clinical data were entered into a database preoperatively and at 1-2 weeks, 3-6 months, and 1 year postoperatively. MR images were evaluated by 3 independent, blinded teams of neurosurgeons and neuroradiologists. The primary endpoint was improvement or resolution of the syrinx. RESULTS: Eight clinical sites were chosen based on the results of a published questionnaire intended to remove geographic and surgeon bias. Data from 68 patients were analyzed after exclusions, and complete clinical and imaging records were obtained for 55 and 58 individuals, respectively. There was strong agreement among the 3 radiology teams, and there was no difference in patient demographics among sites, surgeons, or surgery types. Tonsillar reduction was not associated with > 50% syrinx improvement (RR = 1.22, p = 0.39) or any syrinx improvement (RR = 1.00, p = 0.99). There were no surgical complications. CONCLUSIONS: This study demonstrated the feasibility of a prospective, multicenter surgical trial in CM-I/syringomyelia and provides pilot data indicating no discernible difference in 1-year outcomes between PFDD with and without tonsillar reduction, with power calculations for larger future studies. In addition, the study revealed important technical factors to consider when setting up future trials. The long-term sequelae of tonsillar reduction have not been addressed and would be an important consideration in future investigations.

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Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

January 1, 2020

Volume

25

Issue

1

Start / End Page

21 / 29

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3213 Paediatrics
  • 3209 Neurosciences
  • 1114 Paediatrics and Reproductive Medicine
 

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APA
Chicago
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MLA
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Koueik, J., Sandoval-Garcia, C., Kestle, J. R. W., Rocque, B. G., Frim, D. M., Grant, G. A., … Iskandar, B. J. (2020). Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study. J Neurosurg Pediatr, 25(1), 21–29. https://doi.org/10.3171/2019.8.PEDS19154
Koueik, Joyce, Carolina Sandoval-Garcia, John R. W. Kestle, Brandon G. Rocque, David M. Frim, Gerald A. Grant, Robert F. Keating, et al. “Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study.J Neurosurg Pediatr 25, no. 1 (January 1, 2020): 21–29. https://doi.org/10.3171/2019.8.PEDS19154.
Koueik J, Sandoval-Garcia C, Kestle JRW, Rocque BG, Frim DM, Grant GA, Keating RF, Muh CR, Oakes WJ, Pollack IF, Selden NR, Tubbs RS, Tuite GF, Warf B, Rajamanickam V, Broman AT, Haughton V, Rebsamen S, George TM, Iskandar BJ. Outcomes in children undergoing posterior fossa decompression and duraplasty with and without tonsillar reduction for Chiari malformation type I and syringomyelia: a pilot prospective multicenter cohort study. J Neurosurg Pediatr. 2020 Jan 1;25(1):21–29.

Published In

J Neurosurg Pediatr

DOI

EISSN

1933-0715

Publication Date

January 1, 2020

Volume

25

Issue

1

Start / End Page

21 / 29

Location

United States

Related Subject Headings

  • Neurology & Neurosurgery
  • 3213 Paediatrics
  • 3209 Neurosciences
  • 1114 Paediatrics and Reproductive Medicine