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Fourth ventricle stent placement for treatment of type I Chiari malformation in children

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Abstract

Introduction

Type I Chiari malformation (CM-I) is a common congenital malformation, often accompanied by syringomyelia. Obstruction of CSF circulation in the foramen magnum is the reason for the formation of the syringomyelia. Fourth ventricle stenting (FVS) could ensure the CSF flow from the fourth ventricle, which might represent an effective approach to achieve syringomyelia relief.

Methods

We have reviewed four cases of CM-I children who received FVS implantation from November 2021 to July 2022. Each of the patients underwent FMD. The ventricular catheter of an Ommaya reservoir (Medtronic, Inc.) was used as a stent. Duraplasty was performed with autologous fascia. Cervical MRI rechecks were routinely done 3 months later, and the clinical symptoms were followed up.

Results

Four children received FVS, including one boy and three girls, aged from 12 months to 10 years, with a mean age of 6.8 years. No major complication occurred. The syringomyelia or hydrocephalus in each patient were all attenuated, as observed on the reexamination MRI images. During the follow-up time with a mean of 10.8 months, no patient had new symptoms.

Conclusion

FVS is an effective and safe method for operation of CM-1 in children. The indications of FVS include redo-FMD, difficulties to ensure post-FMD CSF circulation patency at the foramen magnum and with obstructive hydrocephalus. A long-term follow-up duration is necessary.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

    Peng Sun, Mading Zhou, Yutong Liu, Jianxin Du & Gao Zeng

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  1. Peng Sun
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  2. Mading Zhou
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  5. Gao Zeng
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Contributions

Peng Sun: conceptualization, methodology, investigation, writing original draft preparation, writing review and editing. Mading Zhou: data curation.Yutong Liu: investigation. Jianxin Du: supervision. Gao Zeng: conceptualization, writing review and editing, supervision. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Gao Zeng.

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Ethics approval

The present study was approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University. All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Written informed consent was obtained from the patients and their parents.

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Not applicable.

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The authors declare no competing interests.

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Sun, P., Zhou, M., Liu, Y. et al. Fourth ventricle stent placement for treatment of type I Chiari malformation in children. Childs Nerv Syst 39, 671–676 (2023). https://doi.org/10.1007/s00381-022-05793-0

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