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 .
Classification of symptomatic Chiari I malformation to guide surgical strategy.
BACKGROUND Treatment options for Chiari I malformations include posterior fossa decompression ( PFD ) with additional techniques including laminectomy , intradural exploration , and duraplasty . Neuroimaging findings of cisterna magna volume , syringomyelia , and intraoperative ultrasonography may tailor surgical intervention . METHODS We developed an algorithm classifying symptomatic Chiari I patients into three groups to define minimum operation . Without syringomyelia , the presence of cisterna magna defined Group A and the absence defined Group B. Patients with syrinx formed Group C. Mild structural pathology ( Group A ) or adequate space following PFD ( Group B , normal intraoperative ultrasound ( IOUS ) ) should be treated by PFD alone . Conversely , presence of syringomyelia ( Group C ) or inadequate space following PFD ( Group B , abnormal IOUS ) should additionally have duraplasty . We applied this algorithm to patients treated at a single institution over 16 years . RESULTS Twenty-four symptomatic Chiari I malformation patients were divided into three groups that did not differ by age , gender , or extent of tonsillar ectopia . All patients treated by this algorithm experienced clinical and radiographic improvement . This included eight Group B patients who underwent PFD only ( n=6 ) or additional duraplasty ( n=2 ) decided by IOUS . CONCLUSION Treatment of symptomatic Chiari I malformation may have inadequate outcome with conservative strategy or complications with aggressive strategy . This algorithm utilizes preoperative neuroimaging and intraoperative ultrasound to tailor intervention , with excellent clinical outcome and radiographic syrinx resolution on application to 24 patients . Further validation requires prospect i ve multicenter evaluation with larger patient population
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 .