ReviewChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2019
Management of Chiari I malformations: a paradigm in evolution.
Review in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Intraoperative ultrasonography in the surgical management of Chiari I malformation: A systematic review and meta-analysis of outcomes and applications.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Pooled it
- Outcomes of dura-splitting technique compared to conventional duraplasty technique in the treatment of adult Chiari I malformation: a systematic review and meta-analysis.Neurosurgical review · 2021Pooled it
- Preoperative radiological scoring system in Chiari malformation type 1: a surgical guide.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- Septic Shock After Surgery in Arnold-Chiari Malformation Type I: A Case Report.International medical case reports journal · 2025Article
- Utilization of Vestibular Information for Balance Control in Children with Chiari I Malformation.Audiology research · 2024Article
- Optimizing Therapeutic Strategies for Syringomyelia Associated with Tethered Cord Syndrome: A Comprehensive Review.Children (Basel, Switzerland) · 2024Review
- Surgical Outcomes in Chiari 1 and Chiari 1.5 Malformation Treated by Posterior Fossa Reconstruction: A Comprehensive Analysis of 110 Pediatric Cases and Literature Review.Journal of clinical medicine · 2024Article
- Clinical analysis of atlanto-occipital decompression in the management of chiari malformation with multi-segmental syringomyelia.Frontiers in pediatrics · 2024Article
- Clinical and Radiological Outcomes of Dura-Splitting versus Duraplasty Techniques in Pediatric Chiari I Malformation: A Systematic Review and Meta-Analysis.Asian journal of neurosurgery · 2023Review
- Reoperation in Chiari-1 Malformations.Journal of clinical medicine · 2023Article
- Chiari Type 1 Malformation and Syringomyelia in Children: Classification and Treatment Options.Advances and technical standards in neurosurgery · 2023Review
- Article
- Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2022Article
- Clinicoradiographic data and management of children with Chiari malformation type 1 and 1.5: an Italian case series.Acta neurologica Belgica · 2021Article
- Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: which patients are most prone to failure?Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2021Article
- Long-term outcomes for children with an incidentally discovered Chiari malformation type 1: what is the clinical significance?Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2021Article
- The impact of imposed delay in elective pediatric neurosurgery: an informed hierarchy of need in the time of mass casualty crisis.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2020Review
- Complication rates following Chiari malformation surgical management for Arnold-Chiari type I based on surgical variables: A national perspective.Journal of craniovertebral junction & spineArticle
- Timing to surgery of Chiari malformation type 1 affects complication types: An analysis of 13,812 patients.Journal of craniovertebral junction & spineArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDespite decades of experience and research, the etiology and management of Chiari I malformations (CM-I) continue to raise more questions than answers. Controversy abounds in every aspect of management, including the indications, timing, and type of surgery, as well as clinical and radiographic outcomes. This review aims to outline past experiences, consolidate current evidence, and recommend directions for the future management of the Chiari I malformation.
methodsA review of recent literature on the management of CM-I in pediatric patients is presented, along with our experience in managing 1073 patients who were diagnosed with CM-I over the past two decades (1998-2018) at Children's National Medical Center (CNMC) in Washington DC.
resultsThe general trend reveals an increase in the diagnosis of CM-I at younger ages with a significant proportion of these being incidental findings (0.5-3.6%) in asymptomatic patients as well as a rise in the number of patients undergoing Chiari posterior fossa decompression surgery (PFD). The type of surgical intervention varies widely. At our institution, 104 (37%) Chiari surgeries were bone-only PFD with/without outer leaf durectomy, whereas 177 (63%) were PFD with duraplasty. We did not find a significant difference in outcomes between the PFD and PFDD groups (p = 0.59). An analysis of failures revealed a significant difference between patients who underwent tonsillar coagulation versus those whose tonsils were not manipulated (p = 0.02).
conclusionWhile the optimal surgical intervention continues to remain elusive, there is a shift away from intradural techniques in favor of a simple, extradural approach (including dural delamination) in pediatric patients due to high rates of clinical and radiographic success, along with a lower complication rate. The efficacy, safety, and necessity of tonsillar manipulation continue to be heavily contested, as evidence increasingly supports the efficacy and safety of less tonsillar manipulation, including our own experience.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.