Development , validation , and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients
OBJECT Chiari malformation Type I ( CM-I ) is a common and often debilitating neurological disease .
Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes .
Surgical treatment of Chiari I malformation--analysis of intraoperative findings, complications, and outcome for 371 foramen magnum decompressions.
BACKGROUND Foramen magnum decompression is widely accepted as the treatment of choice for Chiari I malformation . However , important surgical details of the procedure are controversial . OBJECTIVE This study analyzes 371 decompressions  focusing on intraoperative findings , analysis of complications , and long-term outcomes . METHODS Among 644 patients between 1985 and 2010 , 359 patients underwent 371 decompressions .  Surgery for symptomatic patients consisted of suboccipital craniectomy , C1 laminectomy , arachnoid dissection , and duraplasty . Short-term results were determined after 3 months ; long-term outcomes were evaluated with Kaplan-Meier statistics . RESULTS The mean age was 40 ± 16 years ; mean follow-up was 49 ± 56 months ; 75.8 % demonstrated syringomyelia . The complication rate was 21.8 % with permanent surgical morbidity of 3.2 % and surgical mortality of 1.3 % . Of the patients , 73.6 % reported improvement after 3 months ; 21 % were unchanged . Overall , 14.3 % demonstrated a neurological deterioration within 5 years and 15.4 % within 10 years . The severity of neurological symptoms correlated with the grade of arachnoid pathology . Outcome data correlated with the number of previous decompressions , severity of arachnoid pathology , h and ling of the arachnoid , type of duraplasty , and surgical experience . First-time decompressions with arachnoid dissection and an alloplastic duraplasty result ed in surgical morbidity for 2.0 % , a 0.9 % mortality rate , postoperative improvement after 3 months for 82 % , and neurological recurrence rates of 7 % after 5 years and 8.7 % after 10 years . CONCLUSION Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results . Decompressions with arachnoid dissection and an alloplastic duraplasty performed by surgeons experienced with this pathology offer a favorable long-term prognosis
Development , validation , and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients
OBJECT Chiari malformation Type I ( CM-I ) is a common and often debilitating neurological disease .
Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes .