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Outcomes for the Surgical Management of Chiari I and Chiari II Malformations

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The Chiari Malformations

Abstract

An up-to-date, evidence-based review of the neurosurgical literature reveals that clinical outcomes following the operative management of Chiari I and II malformations (CM I and CM II) have improved dramatically since these congenital disorders were first recognized as surgical diseases. A detailed assessment of major measurable postoperative parameters—including improvement in clinical signs and symptoms, resolution of syringomyelia, and progression of scoliosis—proves these procedures to be safe and effective when performed in a timely manner by an experienced neurosurgeon. Patients with CM I routinely report a significant reduction in headache, neck pain, apnea, and syrinx-related symptoms and encounter low rates of complication or reoperation after posterior fossa decompression using a bone-only or intradural approach. Neonates and infants with CM II have higher rates of symptomatic improvement and reversal of impairment when an operative intervention is made at the first sign of brain stem dysfunction. The current trend of less invasive bone-only surgical approaches, if shown in larger prospective trials to be superior to traditional decompressions with dural opening, will only add to the modern-day neurosurgeon’s ability to achieve excellent clinical outcomes with minimal risk in the treatment of patients with Chiari I and II malformations.

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Authors and Affiliations

  1. Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida Health Science Center – Jacksonville, Lucy Gooding Pediatric Neurosurgery Center, Wolfson Children’s Hospital, Jacksonville, FL, USA

    Nathan J. Ranalli

  2. Departments of Neurological Surgery and Pediatrics, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA

    David D. Limbrick Jr.

  3. Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, USA

    Tae Sung Park

Authors
  1. Nathan J. Ranalli
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  2. David D. Limbrick Jr.
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  3. Tae Sung Park
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Correspondence to Tae Sung Park .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  2. Department of Neurosurgery, Aydın Adnan Menderes University School of Medicine, Efeler, Aydın, Turkey

    Mehmet Turgut

  3. Departments of Neurosurgery and Pediatrics, University of Alabama, Birmingham, AL, USA

    W. Jerry Oakes

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Ranalli, N.J., Limbrick, D.D., Park, T.S. (2020). Outcomes for the Surgical Management of Chiari I and Chiari II Malformations. In: Tubbs, R., Turgut, M., Oakes, W. (eds) The Chiari Malformations. Springer, Cham. https://doi.org/10.1007/978-3-030-44862-2_45

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  • DOI: https://doi.org/10.1007/978-3-030-44862-2_45

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