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Child's Nervous System

, Volume 24, Issue 11, pp 1333–1339 | Cite as

Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases

  • Matthew J. McGirtEmail author
  • Frank J. Attenello
  • April Atiba
  • Giannina Garces-Ambrossi
  • Ghazala Datoo
  • Jon D. Weingart
  • Benjamin Carson
  • George I. Jallo
Original Paper

Abstract

Objective

Symptom recurrence remains a problem for some patients after surgical decompression for Chiari I malformation. We set out to identify variables at presentation that could identify subgroups most likely to experience incomplete symptom relief after hindbrain decompression for Chiari I malformation.

Materials and methods

We retrospectively reviewed the records of all pediatric patients undergoing first-time suboccipital decompression for Chiari I malformation over a 10-year period. Measured outcomes included (1) persistence or recurrence of symptoms regardless of severity and (2) need for revision decompression.

Results

Two hundred fifty-six children (10 5years old) underwent surgery for Chiari I malformation and were followed up for a mean of 27months. Presenting symptoms included headache in 192 (75%) patients and brainstem or cranial nerve symptoms in 68 (27%) patients. Fifty-seven (22%) patients experienced mild to moderate symptom recurrence. Nineteen (7%) patients required revision decompression for significant symptom recurrence. Headache was 70% more likely to persist or recur versus cranial nerve or brainstem symptoms (relative risk 1.70, p < 0.05). Vertigo and frontal headache independently increased the odds of symptom recurrence 2.9- and 1.5-fold, respectively. Each increasing year of preoperative headache duration was independently associated with 15% increase in likelihood of symptom persistence (p < 0.05). Severe tonsilar ectopia (caudal to C2 lamina) was twice as likely to require revision decompression (14% versus 6%).

Conclusion

In our experience, recurrence of mild symptomatology not severe enough to justify revision surgery may occur in nearly a fifth of patients after surgery. Headache was more likely to recur than objective cranial nerve or brainstem symptoms. Increasing duration of headaches, frontal headaches, and vertigo may be more refractory symptoms of Chiari I malformation.

Keywords

Chiari malformation Predictors Risk factors Outcome 

Notes

Acknowledgment

This work was supported by the American Syringomyelia Alliance Project, Monktin Institute Fellowship.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Matthew J. McGirt
    • 1
    Email author
  • Frank J. Attenello
    • 1
  • April Atiba
    • 1
  • Giannina Garces-Ambrossi
    • 1
  • Ghazala Datoo
    • 1
  • Jon D. Weingart
    • 1
  • Benjamin Carson
    • 1
  • George I. Jallo
    • 1
  1. 1.Department of NeurosurgeryJohns Hopkins School of MedicineBaltimoreUSA

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