Child's Nervous System

, Volume 20, Issue 5, pp 341–348 | Cite as

International survey on the management of Chiari I malformation and syringomyelia

  • Edgardo SchijmanEmail author
  • Paul Steinbok
Focus Session



The availability of magnetic resonance imaging (MRI) has resulted in an increasing number of asymptomatic, minimally symptomatic, and doubtfully symptomatic patients being diagnosed with a Chiari I malformation with or without syringomyelia. In an attempt to clarify how neurosurgeons manage these clinical problems, an international survey on the Chiari I malformation and related syringomyelia was undertaken.


A questionnaire on the expected natural course of the disease and on aspects of the surgical technique for a number of hypothetical cases relating to Chiari I malformation with and without syringomyelia was used to survey Pediatric Neurosurgeons worldwide.


Of 246 questionnaires distributed, 76 (30.8%) were completed and returned. There was a consensus that no operation should be carried out in asymptomatic patients with a Chiari I malformation, unless there is associated syringomyelia. There was a consensus that decompression of the Chiari malformation should be performed in patients with scoliosis when syringomyelia is present, and the majority decompressed the Chiari malformation in scoliotic patients even in the absence of syringomyelia. Suboccipital decompression was the standard surgical procedure for Chiari I malformations. The majority of respondents favored routine dural opening at surgery and closure with a pericranial or synthetic patch graft. In the case of a persistent or progressive syrinx after suboccipital decompression, the majority recommended shunting of the syrinx to the subarachnoid space or to the pleural cavity.


There continues to be much variation in the management of the Chiari I malformation.


Chiari I malformation Syringomyelia International survey Treatment 



We wish to thank those who completed the questionnaire survey: I.R. Abbott, J.M. Abdullah, D. Adelson, V. Balakrishnan, L.T. Basauri, M. Besser, R. Boop, W. Butler, M. Caldarelli, J. Cappelen, S. Constantini, E.M.J. Cornips, A. Czorni, P. Dhellemmes, M.S. Dias, B. Due-Tonnessen, M. Edwards, R.G. Ellenbogen, E. Erdogan, J.P. Farmer, S. Glazier, J.H. Guajardo Torres, S. Haines, A. Hanieh, R. Hayward, M.D. Heafner, E. Helseth, E.J. Herrera, R. Hollenberg, S.K. Hwang, M.A. Ibáñez, Indianapolis Neurosurgery, B.A. Kaufman, Y. Kushel, J.R.S. Leggate, J.F. Martinez-Lage, P.L. May, C. Mazza, J.G. McComb, M. Medlock, G. Meyer, N. Morota, A. Murgio, J. Nadell, M. Panigrahi, A.D. Parent, M. Partington, J.C. Peter, G. Pinna, H. Portnoy, J. Punt, A.G. Ramírez Reyes, H.L. Rekate, P. Richards, A.M. Ritter, F. Rueda Franco, H. Sakamoto, S.K. Sankhla, M. Scott, S. Sgouros, H.J. Shin, M. Shinoda, The Montreal Children’s Hospital Neurosurgery Division, T. Tomita, T. Tsuchida, F. Van Calenbergh, S. Valenzuela, W.P. Vandertop, P. van Ouwerkerk, M. Vassilyadi, E.C.G. Ventureyra, J.H.C. Voormolen, M. Vural, M.L. Walker, K.C. Wang, M. Yamasaki, Y. Yoshida, M. Zerah, G. Zuccaro.


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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Division of NeurosurgeryUniversity of Buenos Aires School of MedicineBuenos AiresArgentina
  2. 2.Section of NeurosurgeryHospital C. DurandBuenos AiresArgentina
  3. 3.Division of Pediatric NeurosurgeryB.C.’s Children’s Hospital, a part of Children’s and Women’s Health CenterVancouverCanada
  4. 4.Department of SurgeryUniversity of British ColumbiaVancouverCanada

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