Journal article
Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data From the Park-Reeves Syringomyelia Research Consortium
Neurosurgery, Vol.88(2), pp.332-341
01/13/2021
DOI: 10.1093/neuros/nyaa460
PMCID: PMC7803430
PMID: 33313928
Abstract
Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology.
To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD.
The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD.
All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P < .001) were increased within the OCF group, whereas only basilar invagination (1/4, P < .001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P = .008) and OCF/VD (115.0 ± 11.6°, P = .025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups.
Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.
Details
- Title: Subtitle
- Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data From the Park-Reeves Syringomyelia Research Consortium
- Creators
- Travis S CreveCoeur - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriAlexander T Yahanda - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriCormac O Maher - Department of Neurosurgery, University of Michigan School of Medicine, Ann Arbor, MichiganGabrielle W Johnson - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriLaurie L Ackerman - Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IndianaP David Adelson - Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, ArizonaRaheel Ahmed - Department of Neurological Surgery, University of Wisconsin at Madison, Madison, WisconsinGregory W Albert - Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, ArkansasPhillipp R Aldana - Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FloridaTord D Alden - Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IllinoisRichard C E Anderson - Division of Pediatric Neurosurgery, Department of Neurological Surgery, Children's Hospital of New York, Columbia-Presbyterian, New York, New YorkLissa Baird - Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OregonDavid F Bauer - Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshireKarin S Bierbrauer - Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OhioDouglas L Brockmeyer - Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UtahJoshua J Chern - Division of Pediatric Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GeorgiaDaniel E Couture - Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North CarolinaDavid J Daniels - Department of Neurosurgery, Mayo Clinic, Rochester, MinnesotaRobert C Dauser - Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TexasSusan R Durham - Department of Neurosurgery, University of Vermont, Burlington, VermontRichard G Ellenbogen - Division of Pediatric Neurosurgery, Seattle Children's Hospital, Seattle, WashingtonRamin Eskandari - Department of Neurosurgery, Medical University of South Carolina, Charleston, South CarolinaHerbert E Fuchs - Department of Neurosurgery, Duke University, Durham, North CarolinaTimothy M George - Division of Pediatric Neurosurgery, Dell Children's Medical Center, Austin, TexasGerald A Grant - Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Palo Alto, CaliforniaPatrick C Graupman - Division of Pediatric Neurosurgery, Gillette Children's Hospital, St. Paul, MinnesotaStephanie Greene - Divsion of Pediatric Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaJeffrey P Greenfield - Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New YorkNaina L Gross - Department of Neurosurgery, University of Oklahoma, Oklahoma City, OklahomaDaniel J Guillaume - Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MinnesotaGabe Haller - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriTodd C Hankinson - Department of Neurosurgery, Children's Hospital Colorado, Aurora, ColoradoGregory G Heuer - Division of Pediatric Neurosurgery, Children's Hospital of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaMark Iantosca - Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PennsylvaniaBermans J Iskandar - Department of Neurological Surgery, University of Wisconsin at Madison, Madison, WisconsinEric M Jackson - Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MarylandAndrew H Jea - Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IndianaJames M Johnston - Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, AlabamaRobert F Keating - Department of Neurosurgery, Children's National Medical Center, Washington, District of ColumbiaMichael P Kelly - Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MissouriNickalus Khan - Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, TennesseeMark D Krieger - Department of Neurosurgery, Children's Hospital of Los Angeles, Los Angeles, CaliforniaJeffrey R Leonard - Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OhioFrancesco T Mangano - Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OhioTimothy B Mapstone - Department of Neurosurgery, University of Oklahoma, Oklahoma City, OklahomaJ Gordon McComb - Department of Neurosurgery, Children's Hospital of Los Angeles, Los Angeles, CaliforniaArnold H Menezes - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaMichael Muhlbauer - Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, TennesseeW Jerry Oakes - Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, AlabamaGreg Olavarria - Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, FloridaBrent R O'Neill - Department of Neurosurgery, Children's Hospital Colorado, Aurora, ColoradoTae Sung Park - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriJohn Ragheb - Department of Neurological Surgery, University of Miami School of Medicine, Miami, FloridaNathan R Selden - Department of Neurological Surgery and Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OregonManish N Shah - Division of Pediatric Neurosurgery, McGovern Medical School, Houston, TexasChevis Shannon - Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, TennesseeJoshua S Shimony - Department of Radiology, Washington University School of Medicine, St. Louis, MissouriJodi Smith - Indiana University IndianapolisMatthew D Smyth - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriScellig S D Stone - Division of Pediatric Neurosurgery, Boston Children's Hospital, Boston, MassachusettsJennifer M Strahle - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriMandeep S Tamber - Department of Neurosurgery, The University of British Columbia, Vancouver, CanadaJames C Torner - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaGerald F Tuite - Department of Neurosurgery, Neuroscience Institute, All Children's Hospital, St. Petersburg, FloridaScott D Wait - Carolina Neurosurgery & Spine Associates, Charlotte, North CarolinaJohn C Wellons - Division of Pediatric Neurosurgery, Monroe Carell Jr Children's Hospital of Vanderbilt University, Nashville, TennesseeWilliam E Whitehead - Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TexasDavid D Limbrick - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.88(2), pp.332-341
- DOI
- 10.1093/neuros/nyaa460
- PMID
- 33313928
- PMCID
- PMC7803430
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Grant note
- UL1 TR002384 / NCATS NIH HHS U54 HD087011 / NICHD NIH HHS P50 HD103525 / NICHD NIH HHS
- Language
- English
- Date published
- 01/13/2021
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984214695602771
Metrics
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