Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document.
Chiari 1 malformation
Children
Consensus
Craniovertebral decompression
Management
Syringomyelia
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
16
01
2021
accepted:
08
05
2021
pubmed:
8
6
2021
medline:
28
1
2022
entrez:
7
6
2021
Statut:
ppublish
Résumé
Chiari malformation type 1 (CM1) is a rare condition where agreed classification and treatment are still missing. The goal of this study is to achieve a consensus on the diagnosis and treatment of CM1 in children. A multidisciplinary panel formulated 57 provisional statements based on a review of the literature. Thirty-four international experts (IE) participated in a Delphi study by independently rating each statement on a 4-point Likert scale ("strongly disagree," "disagree," "agree," "strongly agree"). Statements that were endorsed ("agree" or "strongly agree") by < 75% of raters were re-formulated, or new statements were added, and another Delphi round followed (up to a maximum of three). Thirty-five IE were contacted and 34 agreed to participate. A consensus was reached on 30/57 statements (52.6%) after round 1. Three statements were added, and one removed. After round 2, agreement was reached on 56/59 statements (94.9%). Finally, after round 3, which took place during the 2019 Chiari Consensus Conference (Milan, Italy), agreement was reached on 58/59 statements (98.3%) about four main sections (Definition and Classification, Planning, Surgery, Isolated Syringomyelia). Only one statement did not gain a consensus, which is the "definition of radiological failure 24 month post-surgery." The consensus document consists of 58 statements (24 on diagnosis, 34 on treatment), serving clinicians and researchers following children with CM1. There is a clear need for establishing an international network and registry and to promote collaborative studies to increase the evidence base and optimize the long-term care of this patient population.
Sections du résumé
BACKGROUND
BACKGROUND
Chiari malformation type 1 (CM1) is a rare condition where agreed classification and treatment are still missing. The goal of this study is to achieve a consensus on the diagnosis and treatment of CM1 in children.
METHODS
METHODS
A multidisciplinary panel formulated 57 provisional statements based on a review of the literature. Thirty-four international experts (IE) participated in a Delphi study by independently rating each statement on a 4-point Likert scale ("strongly disagree," "disagree," "agree," "strongly agree"). Statements that were endorsed ("agree" or "strongly agree") by < 75% of raters were re-formulated, or new statements were added, and another Delphi round followed (up to a maximum of three).
RESULTS
RESULTS
Thirty-five IE were contacted and 34 agreed to participate. A consensus was reached on 30/57 statements (52.6%) after round 1. Three statements were added, and one removed. After round 2, agreement was reached on 56/59 statements (94.9%). Finally, after round 3, which took place during the 2019 Chiari Consensus Conference (Milan, Italy), agreement was reached on 58/59 statements (98.3%) about four main sections (Definition and Classification, Planning, Surgery, Isolated Syringomyelia). Only one statement did not gain a consensus, which is the "definition of radiological failure 24 month post-surgery."
CONCLUSIONS
CONCLUSIONS
The consensus document consists of 58 statements (24 on diagnosis, 34 on treatment), serving clinicians and researchers following children with CM1. There is a clear need for establishing an international network and registry and to promote collaborative studies to increase the evidence base and optimize the long-term care of this patient population.
Identifiants
pubmed: 34097175
doi: 10.1007/s10072-021-05317-9
pii: 10.1007/s10072-021-05317-9
pmc: PMC8789635
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1311-1326Informations de copyright
© 2021. The Author(s).
Références
Chai Z, Xue X, Fan H, Sun L, Cai H, Ma Y, Ma C, Zhou R (2018) Efficacy of posterior fossa decompression with duraplasty for patients with Chiari malformation type I: a systematic review and meta-analysis. World Neurosurg 113:357–365
pubmed: 29482005
doi: 10.1016/j.wneu.2018.02.092
Durham SR, Fjeld-Olenec K (2008) Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr 2:42–49
pubmed: 18590394
doi: 10.3171/PED/2008/2/7/042
Lin W, Duan G, Xie J, Shao J, Wang Z, Jiao B (2018) Comparison of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I: a systematic review and meta-analysis. World Neurosurg 110:460–474
pubmed: 29138073
doi: 10.1016/j.wneu.2017.10.161
Lu VM, Phan K, Crowley SP, Daniels DJ (2017) The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation type I: a systematic review and meta-analysis of surgical and performance outcomes. J Neurosurg Pediatr 20:439–449
pubmed: 28885133
doi: 10.3171/2017.6.PEDS16367
Xu H, Chu L, He R, Ge C, Lei T (2017) Posterior fossa decompression with and without duraplasty for the treatment of Chiari malformation type I-a systematic review and meta-analysis. Neurosurg Rev 40:213–221
pubmed: 27251046
doi: 10.1007/s10143-016-0731-x
Zhao JL, Li MH, Wang CL, Meng W (2016) A systematic review of Chiari I malformation: techniques and outcomes. World Neurosurg 88:7–14
pubmed: 26732952
doi: 10.1016/j.wneu.2015.11.087
Canheu AC, Santos MV, Furlanetti LL, Salomão JFM, de Oliveira RS (2020) The Brazilian Society for Pediatric Neurosurgery: consensus on Chiari I deformity. Childs Nerv Syst 36:17–18
pubmed: 31705187
doi: 10.1007/s00381-019-04413-8
Haroun RI, Guarnieri M, Meadow JJ, Kraut M, Carson BS (2000) Current opinions for the treatment of syringomyelia and Chiari malformations: survey of the Pediatric Section of the American Association of Neurological Surgeons. Pediatr Neurosurg 33:311–317
pubmed: 11182642
doi: 10.1159/000055977
Schijman E, Steinbok P (2004) International survey on the management of Chiari I malformation and syringomyelia. Childs Nerv Syst 20:341–348
pubmed: 14966661
doi: 10.1007/s00381-003-0882-2
Singhal A, Cheong A, Steinbok P (2018) International survey on the management of Chiari 1 malformation and syringomyelia: evolving worldwide opinions. Childs Nerv Syst 34:1177–1182
pubmed: 29532166
doi: 10.1007/s00381-018-3741-x
Ciaramitaro P, Garbossa D, Peretta P, Piatelli G, Massimi L, Valentini L, Migliaretti G, Baldovino S, Roccatello D, Kodra Y, Taruscio D (2020) Interregional Chiari and Syringomyelia Consortium; on behalf of the Interregional Chiari and Syringomyelia Consortium. Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort. Ann Ist Super Sanita 56:48–58
pubmed: 32242535
Ciaramitaro P, Cruccu G, de Tommaso M, Devigili G, Fornasari D, Geppetti P, Lacerenza M, Lauria G, Mameli S, Marchettini P, Nolano M, Polati E, Provitera V, Romano M, Solaro C, Tamburin S, Tugnoli V, Valeriani M, Truini A (2019) Neuropathic Pain Special Interest Group of the Italian Neurological Society. A Delphi consensus statement of the Neuropathic Pain Special Interest Group of the Italian Neurological Society on pharmacoresistant neuropathic pain. Neurol Sci 40:1425–1431
pubmed: 30941628
doi: 10.1007/s10072-019-03870-y
Bolognese PA, Brodbelt A, Bloom AB, Kula RW (2019) Chiari I malformation: opinions on diagnostic trends and controversies from a panel of 63 international experts. World Neurosurg 130:e9–e16
pubmed: 31121369
doi: 10.1016/j.wneu.2019.05.098
Blegvad C, Grotenhuis JA, Juhler M (2014) Syringomyelia: a practical, clinical concept for classification. Acta Neurochir 156:2127–2138
pubmed: 25236931
doi: 10.1007/s00701-014-2229-z
Klekamp J (2018) How should syringomyelia be defined and diagnosed? World Neurosurg 111:e729–e745
pubmed: 29317358
doi: 10.1016/j.wneu.2017.12.156
Milhorat TH (2000) Classification of syringomyelia. Neurosurg Focus 8:E1
pubmed: 16676921
doi: 10.3171/foc.2000.8.3.1
Shen J, Shen J, Huang K, Wu Y, Pan J, Zhan R (2019) Syringobulbia in patients with Chiari malformation type I: a systematic review. Biomed Res Int 2019:4829102
pubmed: 31016190
pmcid: 6444244
doi: 10.1155/2019/4829102
Milhorat TH, Johnson RW, Milhorat RH, Capocelli AL Jr (1995) Pevsner PH (1995) Clinicopathological correlations in syringomyelia using axial magnetic resonance imaging. Neurosurgery 37:206–213
pubmed: 7477770
doi: 10.1227/00006123-199508000-00003
Milhorat TH, Kotzen RM, Mu HT, Capocelli AL Jr, Milhorat RH (1996) Dysesthetic pain in patients with syringomyelia. Neurosurgery 38:940–946
pubmed: 8727819
doi: 10.1097/00006123-199605000-00017
Massimi L, Della Pepa GM, Caldarelli M, Di Rocco C (2012) Abrupt clinical onset of Chiari type I/syringomyelia complex: clinical and physiopathological implications. Neurosurg Rev 35:321–329
pubmed: 22527630
doi: 10.1007/s10143-012-0391-4
Strahle J, Geh N, Selzer BJ, Bower R, Himedan M, Strahle M, Wetjen NM, Muraszko KM, Garton HJ, Maher CO (2016) Sports participation with Chiari I malformation. J Neurosurg Pediatr 17:403–409
pubmed: 26636249
doi: 10.3171/2015.8.PEDS15188
Talamonti G, Marcati E, Gribaudi G, Picano M, D’Aliberti G (2020) Acute presentation of Chiari 1 malformation in children. Childs Nerv Syst 36:899–909
pubmed: 32055974
doi: 10.1007/s00381-020-04540-7
Granata T, Valentini LG (2011) Epilepsy in type 1 Chiari malformation. Neurol Sci 32 Suppl 3:S303–S306
pubmed: 21796429
doi: 10.1007/s10072-011-0697-y
Marianayagam NJ, Shalom NB, Zarchi O, Michowiz S, Margalit N, Rajz G (2020) Conservative management for pediatric patients with Chiari 1 anomaly: a retrospective study. Clin Neurol Neurosurg 189:105615
pubmed: 31786431
doi: 10.1016/j.clineuro.2019.105615
Jayarao M, Sohl K, Tanaka T (2015) Chiari malformation I and autism spectrum disorder: an underrecognized coexistence. J Neurosurg Pediatr 15:96–100
pubmed: 25396704
doi: 10.3171/2014.10.PEDS13562
Riva D, Usilla A, Saletti V, Esposito S, Bulgheroni S (2011) Can Chiari malformation negatively affect higher mental functioning in developmental age? Neurol Sci 32 Suppl 3:S307–S309
pubmed: 21983865
doi: 10.1007/s10072-011-0779-x
Rogers JM, Savage G, Stoodley MA (2018) A systematic review of cognition in Chiari I malformation. Neuropsychol Rev 28:176–187
pubmed: 29468516
doi: 10.1007/s11065-018-9368-6
Strahle J, Maher CO (2015) Letter to the Editor: Chiari malformation I and autism spectrum disorder. J Neurosurg Pediatr 16:609–610
pubmed: 26273740
doi: 10.3171/2015.2.PEDS1571
Lumish HS, Wynn J, Devinsky O, Chung WK (2015) Brief Report: SETD2 mutation in a child with autism, intellectual disabilities and epilepsy. J Autism Dev Disord 45:3764–3770
pubmed: 26084711
doi: 10.1007/s10803-015-2484-8
Osuagwu FC, Amalraj B, Noveloso BD, Aikoye SA, Bradley R (2016) Autism spectrum disorder and Chiari 1 malformation co-occurring in a child. Tokai J Exp Clin Med 41:54–56
pubmed: 27050897
Saletti V, Esposito S, Maccaro A, Giglio S, Valentini LG, Chiapparini L (2017) Chiari I malformation in a child with PTEN hamartoma tumor syndrome: association or coincidence? Eur J Med Genet 60:261–264
pubmed: 28286253
doi: 10.1016/j.ejmg.2017.03.002
Saletti V, Viganò I, Melloni G, Pantaleoni C, Vetrano IG, Valentini LG (2019) Chiari I malformation in defined genetic syndromes in children: are there common pathways? Childs Nerv Syst 35:1727–1739
pubmed: 31363831
doi: 10.1007/s00381-019-04319-5
Benglis D Jr, Covington D, Bhatia R, Bhatia S, Elhammady MS, Ragheb J, Morrison G, Sandberg DI (2011) Outcomes in pediatric patients with Chiari malformation type I followed up without surgery. J Neurosurg Pediatr 7:375–379
pubmed: 21456908
doi: 10.3171/2011.1.PEDS10341
Novegno F, Caldarelli M, Massa A, Chieffo D, Massimi L, Pettorini B, Tamburrini G, Di Rocco C (2008) The natural history of the Chiari type I anomaly. J Neurosurg Pediatr 2:179–187
pubmed: 18759599
doi: 10.3171/PED/2008/2/9/179
Singhal A, Bowen-Roberts T, Steinbok P, Cochrane D, Byrne AT, Kerr JM (2011) Natural history of untreated syringomyelia in pediatric patients. Neurosurg Focus 31:E13
pubmed: 22133172
doi: 10.3171/2011.9.FOCUS11208
Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO (2011) Natural history of Chiari malformation type I following decision for conservative treatment. J Neurosurg Pediatr 8:214–221
pubmed: 21806365
doi: 10.3171/2011.5.PEDS1122
Ciaramitaro P, Ferraris M, Massaro F, Garbossa D (2019) Clinical diagnosis-part I: what is really caused by Chiari I. Childs Nerv Syst 35:1673–1679
pubmed: 31161267
doi: 10.1007/s00381-019-04206-z
Novegno F (2019) Clinical diagnosis-part II: what is attributed to Chiari I. Childs Nerv Syst 35:1681–1693
pubmed: 31093732
doi: 10.1007/s00381-019-04192-2
Mehta A, Chilakamarri P, Zubair A, Kuruvilla D (2018) Chiari headache. Curr Pain Headache Rep 22:49
pubmed: 29904826
doi: 10.1007/s11916-018-0702-8
Victorio MC, Khoury CK (2016) Headache and Chiari I malformation in children and adolescents. Semin Pediatr Neurol 23:35–39
pubmed: 27017020
doi: 10.1016/j.spen.2016.01.001
Kawasaki Y, Uchida S, Onishi K, Toyokuni M, Okanari K, Fujiki M (2017) Intraoperative neurophysiologic monitoring for prediction of postoperative neurological improvement in a child with Chiari type I malformation. J Craniofac Surg 28:1837–1841
pubmed: 28863007
doi: 10.1097/SCS.0000000000003926
Roser F, Ebner FH, Liebsch M, Tatagiba MS, Naros G (2016) The role of intraoperative neuromonitoring in adults with Chiari I malformation. Clin Neurol Neurosurg 150:27–32
pubmed: 27573703
doi: 10.1016/j.clineuro.2016.08.019
Leu RM (2015) Sleep-related breathing disorders and the Chiari 1 malformation. Chest 148:1346–1352
pubmed: 26158759
doi: 10.1378/chest.14-3090
Losurdo A, Dittoni S, Testani E, Di Blasi C, Scarano E, Mariotti P, Paternoster G, Di Rocco C, Massimi L, Della Marca G (2013) Sleep disordered breathing in children and adolescents with Chiari malformation type I. J Clin Sleep Med 9:371–377
pubmed: 23585753
pmcid: 3601316
doi: 10.5664/jcsm.2592
Zaffanello M, Sala F, Sacchetto L, Gasperi E, Piacentini G (2017) Evaluation of the central sleep apnea in asymptomatic children with Chiari 1 malformation: an open question. Childs Nerv Syst 33:829–832
pubmed: 28382434
doi: 10.1007/s00381-017-3399-9
Amin R, Sayal P, Sayal A, Massicote C, Pham R, Al-Saleh S, Drake J, Narang I (2015) The association between sleep-disordered breathing and magnetic resonance imaging findings in a pediatric cohort with Chiari 1 malformation. Can Respir J 22:31–36
pubmed: 25379655
pmcid: 4324522
doi: 10.1155/2015/831569
Massimi L, Pennisi G, Frassanito P, Tamburrini G, Di Rocco C, Caldarelli M (2019) Chiari type I and hydrocephalus. Childs Nerv Syst 35:1701–1709
pubmed: 31227858
doi: 10.1007/s00381-019-04245-6
Hayhurst C, Osman-Farah J, Das K, Mallucci C (2008) Initial management of hydrocephalus associated with Chiari malformation type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis. J Neurosurg 108:1211–1214
pubmed: 18518729
doi: 10.3171/JNS/2008/108/6/1211
Massimi L, Pravatà E, Tamburrini G, Gaudino S, Pettorini B, Novegno F, Colosimo C Jr, Di Rocco C (2011) Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications. Neurosurgery 68:950–956
pubmed: 21221038
doi: 10.1227/NEU.0b013e318208f1f3
Valentini LG, Saletti V, Erbetta A, Chiapparini L, Furlanetto M (2019) Chiari 1 malformation and untreated sagittal synostosis: a new subset of complex Chiari? Childs Nerv Syst 35:1741–1753
pubmed: 31327038
doi: 10.1007/s00381-019-04283-0
Afshari FT, Solanki GA, Lo WB, Rodrigues D (2020) Posterior calvarial augmentation for Chiari malformation type 1 refractory to foramen magnum decompression. World Neurosurg 139:70–74
pubmed: 32298820
doi: 10.1016/j.wneu.2020.03.218
Thompson DN, Hayward RD, Harkness WJ, Bingham RM, Jones BM (1995) Lessons from a case of kleeblattschädel. Case report. J Neurosurg 82:1071–1074
pubmed: 7760182
doi: 10.3171/jns.1995.82.6.1071
Massimi L, Peraio S, Peppucci E, Tamburrini G, Di Rocco C (2011) Section of the filum terminale: is it worthwhile in Chiari type I malformation? Neurol Sci 32 Suppl 3:S349–S351
pubmed: 21800080
doi: 10.1007/s10072-011-0691-4
Glenn C, Cheema AA, Safavi-Abbasi S, Gross NL, Martin MD, Mapstone TB (2015) Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations. J Clin Neurosci 22:1749–1752
pubmed: 26165471
doi: 10.1016/j.jocn.2015.05.023
Steinbok P, MacNeily AE, Hengel AR, Afshar K, Landgraf JM, Hader W, Pugh J (2016) Filum section for urinary incontinence in children with occult tethered cord syndrome: a randomized, controlled pilot study. J Urol 195(4 Pt 2):1183–1188
pubmed: 26926544
doi: 10.1016/j.juro.2015.09.082
Milano JB, Barcelos ACES, Onishi FJ, Daniel JW, Botelho RV, Dantas FR, Neto ER, de Freitas Bertolini E, Mudo ML, Brock RS, de Oliveira RS, Joaquim AF (2020) The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review. Neurol Sci 41:249–256
pubmed: 31598783
doi: 10.1007/s10072-019-04056-2
Valentini LG, Selvaggio G, Visintini S, Erbetta A, Scaioli V, Solero CL (2011) Tethered cord: natural history, surgical outcome and risk for Chiari malformation 1 (CM1): a review of 110 detethering. Neurol Sci 32(Suppl 3):S353–S356
pubmed: 21922314
doi: 10.1007/s10072-011-0745-7
Jiang E, Sha S, Yuan X, Zhu W, Jiang J, Ni H, Liu Z, Qiu Y, Zhu Z (2018) Comparison of clinical and radiographic outcomes for posterior fossa decompression with and without duraplasty for treatment of pediatric Chiari I malformation: a prospective study. World Neurosurg 110:e465–e472
pubmed: 29133007
doi: 10.1016/j.wneu.2017.11.007
Foreman P, Safavi-Abbasi S, Talley MC, Boeckman L, Mapstone TB (2012) Perioperative outcomes and complications associated with allogeneic duraplasty for the management of Chiari malformations type I in 48 pediatric patients. Neurosurg Pediatr 10:142–149
doi: 10.3171/2012.5.PEDS11406
Martínez-Lage JF, Pérez-Espejo MA, Palazón JH, López Hernández F, Puerta P (2006) Autologous tissues for dural grafting in children: a report of 56 cases. Childs Nerv Syst 22:139–144
pubmed: 16187146
doi: 10.1007/s00381-005-1232-3
Noguchi-Shinohara M, Hamaguchi T, Kitamoto T, Sato T, Nakamura Y, Mizusawa H, Yamada M (2007) Clinical features and diagnosis of dura mater graft associated Creutzfeldt Jakob disease. Neurology 69:360–367
pubmed: 17646628
doi: 10.1212/01.wnl.0000266624.63387.4a
Greenberg JK, Milner E, Yarbrough CK, Lipsey K, Piccirillo JF, Smyth MD, Park TS, Limbrick DD Jr (2015) Outcome methods used in clinical studies of Chiari malformation type I: a systematic review. J Neurosurg 122:262–272
pubmed: 25380104
doi: 10.3171/2014.9.JNS14406
Furtado SV, Thakar S, Hegde AS (2011) Correlation of functional outcome and natural history with clinicoradiological factors in surgically managed pediatric Chiari I malformation. Neurosurgery 68:319–327
pubmed: 21135728
doi: 10.1227/NEU.0b013e31820206e5
Kennedy BC, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Anderson RC, Feldstein NA (2015) Outcomes after suboccipital decompression without dural opening in children with Chiari malformation type I. J Neurosurg Pediatr 16:150–158
pubmed: 25932779
pmcid: 4593701
doi: 10.3171/2014.12.PEDS14487
Massimi L, Frassanito P, Bianchi F, Tamburrini G, Caldarelli M (2019) Bony decompression vs duraplasty for Chiari I malformation: does the eternal dilemma matter? Childs Nerv Syst 35:1827–1838
pubmed: 31209642
doi: 10.1007/s00381-019-04218-9
Massimi L, Frassanito P, Chieffo D, Tamburrini G, Caldarelli M (2019) Bony decompression for Chiari malformation type I: long-term follow-up. Acta Neurochir Suppl 125:119–124
pubmed: 30610311
doi: 10.1007/978-3-319-62515-7_17
Mazzola CA, Fried AH (2003) Revision surgery for Chiari malformation decompression. Neurosurg Focus 15:E3
pubmed: 15347221
doi: 10.3171/foc.2003.15.3.3
Alexander H, Tsering D, Myseros JS, Magge SN, Oluigbo C, Sanchez CE, Keating RF (2019) Management of Chiari I malformations: a paradigm in evolution. Childs Nerv Syst 35:1809–1826
pubmed: 31352576
doi: 10.1007/s00381-019-04265-2
Noureldine MHA, Shimony N, Jallo G, Groves ML (2019) Scoliosis in patients with Chiari malformation type I. Childs Nerv Syst 35:1853–1862
pubmed: 31342150
doi: 10.1007/s00381-019-04309-7
Strahle JM, Taiwo R, Averill C, Torner J, Gewirtz JI, Shannon CN, Bonfield CM, Tuite GF, Bethel-Anderson T, RCE A, Kelly MP, Shimony JS, Dacey RG, Smyth MD, Park TS, Limbrick DD, Park-Reeves Syringomyelia Research Consortium (2020) Radiological and clinical associations with scoliosis outcomes after posterior fossa decompression in patients with Chiari malformation and syrinx from the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr 10:1–7
Chatterjee S, Shivhare P, Verma SG (2019) Chiari malformation and atlantoaxial instability: problems of co-existence. Childs Nerv Syst 35:1755–1761
pubmed: 31302728
doi: 10.1007/s00381-019-04284-z
Ho WSC, Brockmeyer DL (2019) Complex Chiari malformation: using craniovertebral junction metrics to guide treatment. Childs Nerv Syst 35:1847–1851
pubmed: 31139903
doi: 10.1007/s00381-019-04214-z
Goel A (2018) Basilar invagination, syringomyelia and Chiari formation and their relationship with atlantoaxial instability. Neurol India 66:940–942
pubmed: 30038072
doi: 10.4103/0028-3886.236992
Goel A, Kaswa A, Shah A (2019) Atlantoaxial fixation for treatment of chiari formation and syringomyelia with no craniovertebral bone anomaly: report of an experience with 57 cases. Acta Neurochir Suppl 125:101–110
pubmed: 30610309
doi: 10.1007/978-3-319-62515-7_15
Chotai S, Chan EW, Ladner TR, Hale AT, Gannon SR, Shannon CN, Bonfield CM, Naftel RP, Wellons JC (2020) Timing of syrinx reduction and stabilization after posterior fossa decompression for pediatric Chiari malformation type I. J Neurosurg Pediatr 24:1–7
Hale AT, Adelson PD, Albert GW, Aldana PR, Alden TD, Anderson RCE, Bauer DF, Bonfield CM, Brockmeyer DL, Chern JJ, Couture DE, Daniels DJ, Durham SR, Ellenbogen RG, Eskandari R, George TM, Grant GA, Graupman PC, Greene S, Greenfield JP, Gross NL, Guillaume DJ, Heuer GG, Iantosca M, Iskandar BJ, Jackson EM, Johnston JM, Keating RF, Leonard JR, Maher CO, Mangano FT, McComb JG, Meehan T, Menezes AH, O’Neill B, Olavarria G, Park TS, Ragheb J, Selden NR, Shah MN, Smyth MD, Stone SSD, Strahle JM, Wait SD, Wellons JC, Whitehead WE, Shannon CN, Limbrick DD, Park-Reeves Syringomyelia Research Consortium Investigators (2020) Factors associated with syrinx size in pediatric patients treated for Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr 6:1–11
Massimi L, Novegno F, di Rocco C (2011) Chiari type I malformation in children. Adv Tech Stand Neurosurg 37:143–211
doi: 10.1007/978-3-7091-0673-0_6
Joseph RN, Batty R, Raghavan A, Sinha S, Griffiths PD, Connolly DJ (2013) Management of isolated syringomyelia in the paediatric population--a review of imaging and follow-up in a single Centre. Br J Neurosurg 27:683–686
pubmed: 23472665
doi: 10.3109/02688697.2013.771728
Magge SN, Smyth MD, Governale LS, Goumnerova L, Madsen J, Munro B, Nalbach SV, Proctor MR, Scott RM, Smith ER (2011) Idiopathic syrinx in the pediatric population: a combined center experience. J Neurosurg Pediatr 7:30–36
pubmed: 21194284
doi: 10.3171/2010.10.PEDS1057
Rodriguez A, Kuhn EN, Somasundaram A, Couture DE (2015) Management of idiopathic pediatric syringohydromyelia. J Neurosurg Pediatr 16:452–457
pubmed: 26207665
doi: 10.3171/2015.3.PEDS14433
Soleman J, Roth J, Constantini S (2019) Direct syrinx drainage in patients with Chiari I malformation. Childs Nerv Syst 35:1863–1868
pubmed: 31152219
doi: 10.1007/s00381-019-04228-7