ArticleJournal of neurosurgery. Pediatrics2021
Expansile duraplasty and obex exploration compared with bone-only decompression for Chiari malformation type I in children: retrospective review of outcomes and complications.
Article in Journal of neurosurgery. Pediatrics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Hidden impacts, visible deficits: a comprehensive systematic literature review of the cognitive impairment in patients with Chiari malformation type I.Neurosurgical review · 2025Pooled it
- Extradural foramen magnum decompression with multiple superficial dural incisions for Chiari I malformation: a multicenter series of 91 pediatric patients.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- Predecompression and postdecompression cognitive and affective changes in Chiari malformation type I.Journal of neurosurgery · 2025Article
- Long-term outcomes following posterior fossa decompression in pediatric patients with Chiari malformation type 1, a population-based cohort study.Acta neurochirurgica · 2024Article
- Predicting the presence of 4th ventricular outlet obstruction in Chiari I Malformation.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024Article
- Long-term outcome of operated Chiari I patients between 2005 and 2020 in Eastern Finland.Acta neurochirurgica · 2024Article
- Chiari malformation type 1 presenting as isolated unilateral foot drop with rapid recovery following posterior fossa decompression.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2022Review
- Precise Management of Chiari Malformation with Type I.Frontiers in surgery · 2022Review
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveWhile a select population of pediatric patients with Chiari malformation type I (CM-I) remain asymptomatic, some patients present with tussive headaches, neurological deficits, progressive scoliosis, and other debilitating symptoms that necessitate surgical intervention. Surgery entails a variety of strategies to restore normal CSF flow, including increasing the posterior fossa volume via bone decompression only, or bone decompression with duraplasty, with or without obex exploration. The indications for duraplasty and obex exploration following bone decompression remain controversial. The objective of this study was to describe an institutional series of pediatric patients undergoing surgery for CM-I, performed by a single neurosurgeon. For patients presenting with a syrinx, the authors compared outcomes following bone-only decompression with duraplasty only and with duraplasty including obex exploration. Clinical outcomes evaluated included resolution of syrinx, scoliosis, presenting symptoms, and surgical complications.
methodsA retrospective review was conducted of the medical records of 276 consecutive pediatric patients with CM-I operated on at a single institution between 2001 and 2015 by the senior author. Imaging findings of tonsillar descent, associated syrinx (syringomyelia or syringobulbia), basilar invagination, and clinical assessment of CM-I-attributable symptoms and scoliosis were recorded. In patients presenting with a syrinx, clinical outcomes, including syrinx resolution, symptom resolution, and impact on scoliosis progression, were compared for three surgical groups: bone-only/posterior fossa decompression (PFD), PFD with duraplasty (PFDwD), and PFD with duraplasty and obex exploration (PFDwDO).
resultsPFD was performed in 25% of patients (69/276), PFDwD in 18% of patients (50/276), and PFDwDO in 57% of patients (157/276). The mean follow-up was 35 ± 35 months. Nearly half of the patients (132/276, 48%) had a syrinx. In patients presenting with a syrinx, PFDwDO was associated with a significantly higher likelihood of syrinx resolution relative to PFD only (HR 2.65, p = 0.028) and a significant difference in time to symptom resolution (HR 2.68, p = 0.033). Scoliosis outcomes did not differ among treatment groups (p = 0.275). Complications were not significantly higher when any duraplasty (PFDwD or PFDwDO) was performed following bone decompression (p > 0.99).
conclusionsIn this series of pediatric patients with CM-I, patients presenting with a syrinx who underwent expansile duraplasty with obex exploration had a significantly greater likelihood of syrinx and symptom resolution, without increased risk of CSF-related complications, compared to those who underwent bone-only decompression.
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