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 .
Posterior fossa volume increase after surgery for Chiari malformation Type I: a quantitative assessment using magnetic resonance imaging and correlations with the treatment response.
OBJECT The aim of this paper was to measure the posterior fossa ( PF ) volume increase result ing from a given-sized occipital craniectomy in Chiari malformation Type I surgery and to analyze its correlations with the PF size and the treatment response , with the perspective of tailoring the amount of bone removal to the patient-specific PF dimensions . METHODS Between January 2005 and June 2006 , 11 adult patients with symptomatic Chiari malformation Type I underwent a st and ardized PF decompression . A prospect i ve evaluation with clinical examination , functional grading , and MR imaging measurement protocol s was performed pre- and postoperatively . A method is reported for the measurement of PF volume ( PFV ) after surgery . The degree of PFV increase was compared with the preoperative size of the PF and with the clinical outcome . RESULTS All 11 patients  improved postoperatively , with complete and partial recovery in 4 and 7 patients , respectively . No postoperative complication occurred after a mean follow-up period of 45 months . The mean relative increase in PFV accounted for 10 % ( range 1.5%-19.7 % ) of the initial PFV ; the increase was greater in cases in which the PF was small ( r = -0.52 , p = 0.09 ) and the basiocciput was short ( r = -0.37 , p = 0.2 ) . A statistically significant positive correlation was found between the degree of PFV increase and the treatment response ( p = 0.014 ) ; complete recovery was observed with a PFV increase of 15 % and partial recovery with an increase of 7 % . CONCLUSIONS The treatment response is significantly influenced by the degree of PFV increase , which is dependent on the size of the PF and the extent of the craniectomy , suggesting that the optimal patient-specific PFV increase could be predicted on the basis of preoperative MR imaging and enhancing the perspective that the craniectomy size could be tailored to the individual PFV
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 .