Evidence map›Paper›PMID 41535441›Full record

ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2026

Individuation of predictive parameters of posterior cranial fossa decompression in pediatric patients with Chiari I malformation and autism spectrum disorder.

Elena Ferri, Alice Noris, Tayler Appleton, Simone Peraio, Andrea Di Rita, Chiara Spezzani, Roberta Battini, Ludovico D'Incerti, Matteo Lenge, Michela Sica and 5 more

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Article in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Elena FerriDepartment of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy. elena.ferri@unifi.it.
Alice NorisDepartment of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Tayler AppletonCollege of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Simone PeraioDepartment of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Andrea Di RitaDepartment of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Chiara SpezzaniDepartment of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Roberta BattiniDepartment of Neuroscience, IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy.
Ludovico D'IncertiPediatric Neuroradiology Unit, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Matteo LengeInnovation Center, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Michela SicaClinical Trial Office, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Letizia MacconiPediatric Radiology Unit, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Luca MesinMathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico Di Torino, Turin, Italy.
Matilda FontanarosaMathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico Di Torino, Turin, Italy.
Matteo RaggiMathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico Di Torino, Turin, Italy.
Flavio GiordanoDepartment of Neurosurgery, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThere are no specific guidelines for posterior cranial fossa decompression (PCFD) in asymptomatic Chiari Malformation Type I (CM-I) patients with autism spectrum disorder (ASD). However, some studies suggest that surgery for symptomatic CM-I may improve ASD symptoms. This study aims to identify skull and brain morphometric parameters that could predict surgical outcomes in symptomatic CM-I with ASD, using artificial intelligence (AI).

methodsThis study included pediatric patients diagnosed with both symptomatic CM-I and ASD who underwent posterior cranial fossa (PCF) surgery. Eleven morphometric parameters were measured using computed tomography (CT) and magnetic resonance imaging (MRI) scans, including cerebellar tonsil descent, tentorium length and angle, cerebellum-to-PCF area ratio, PCF-to-cerebrum area ratio, PCF height and diameter, and various distances involving the corpus callosum, pons, fastigium, foramen magnum, and clivus length. ASD symptom changes were assessed through phone interviews and outpatient evaluations. A binary tree classifier AI model was used to identify patients who improved post-surgically.

resultsOur analysis showed that patients with a larger tentorium angle experienced some improvements in ASD symptoms after surgery, whereas those with a significantly smaller tentorium angle showed no improvement. AI identified a tentorium angle of 89.55° as a potential cut-off for distinguishing between outcome groups. No other morphometric parameters significantly influenced ASD symptom outcomes.

conclusionsThis study evaluates the relevance of the tentorium angle width as a potentially valuable MRI-based morphometric parameter that could guide neurosurgeons in the decision-making process for this unique patient population. These findings may contribute to a more tailored approach for managing patients with CM-I and coexistent ASD.

Indexed as

Arnold-Chiari MalformationAutism Spectrum DisorderCranial Fossa, PosteriorDecompression, SurgicalAdolescentChildChild, PreschoolFemaleHumansMagnetic Resonance ImagingMaleTomography, X-Ray ComputedTreatment OutcomeAutism spectrum disorderChiari malformation IMachine learningMorphometric measurementPosterior cranial fossa decompressionTentorium angle

Identifiers

PMID41535441

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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.