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International survey on the management of Chiari I malformation and syringomyelia

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Abstract

Introduction

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.

Method

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.

Results

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.

Conclusion

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

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Acknowledgements

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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Authors and Affiliations

  1. Division of Neurosurgery, University of Buenos Aires School of Medicine, Av Libertador 2698 1-F, (1425), Buenos Aires, Argentina

    Edgardo Schijman

  2. Section of Neurosurgery, Hospital C. Durand, Buenos Aires, Argentina

    Edgardo Schijman

  3. Division of Pediatric Neurosurgery, B.C.’s Children’s Hospital, a part of Children’s and Women’s Health Center, Vancouver, Canada

    Paul Steinbok

  4. Department of Surgery, University of British Columbia, Vancouver, Canada

    Paul Steinbok

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  1. Edgardo Schijman
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Correspondence to Edgardo Schijman.

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Schijman, E., Steinbok, P. International survey on the management of Chiari I malformation and syringomyelia. Childs Nerv Syst 20, 341–348 (2004). https://doi.org/10.1007/s00381-003-0882-2

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  • DOI: https://doi.org/10.1007/s00381-003-0882-2

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