Pediatric Chiari Malformations Type I: Comparison of The Results of Two Surgical Techniques

OUEDRAOGO Narcisse Wendpuiré Mike1, TRAVERS Nadine2, DAO Ibrahim1, ZABSONRE Denlewendé Sylvain3 and KABRÉ Abel3
1Department of Orthopaedic and Trauma Surgery/Sourô Sanou University Hospital, Bobo-Dioulasso, Burkina Faso
2Department of Pediatric Head and Neck Surgery/Hôpital Gatien de Clocheville/Centre Hospitalier Universitaire Régional, Tours, France
3Neurosurgery Department/Yalgado Ouédraogo University Hospital, Ouagadougou, Burkina Faso
DOI – http://doi.org/10.37502/IJSMR.2024.7907

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Abstract

Introduction: Chiari type I malformation is a bulbous-medullary junction malformation that occurs more frequently in the pediatric population. When symptomatic, it is surgically treated. The aim of our study was to evaluate the postoperative evolution in children according to the surgical technique.

Material and methods: This was a retrospective study carried out in the neurosurgery department of the Regional University Hospital (CHRU) of Tours over a period of 14 years, covering all children who underwent surgery for a type I Chiari malformation.

Results: Forty-eight patients were included in the study. The mean age was 104.4 months. Girls were in the majority because the sex ratio was 0.71. Older children (2-12 years) were the most represented group (62.5%). The clinical picture were dominated by headaches (62.42%) and scoliosis (20.83%). The mean descent of the cerebellar tonsils was 11.94 mm, and 19 (39.58%) children had syringomyelia. Thirty-one children benefited from a dural and arachnoid opening combined with dural plasty, and 17 from an extra-arachnoid opening without dural plasty. Post-operative outcome was better for dural and arachnoid openings with plasty.

Conclusion: Symptomatic Chiari type I malformations are more common in children aged 2-12 years. Dural and arachnoid openings with plasty were associated with fewer postoperative complications and shorter hospital stays than extra-arachnoid dural openings without plasty.

Keywords: Chiari malformation, syringomyelia, FCP craniectomy, pediatric neurosurgery.

References

  • Chiari H. Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. Pediatr Neurosci. 1987; 13:3–8.
  • Jarski P, Zimny M, Linart M, Kozłowska Z, Mandera M. Results of the surgical treatment in children with Chiari malformation type I. Childs Nerv Syst. 2019;35(10):1911‑4.
  • Kahle W, Frotscher M. Atlas de poche d’anatomie. 3. Système nerveux et organes de sens. 4ème éd. Paris: Flammarion Médecine-Sciences; 2007. 423 p.
  • Cho SB, Baek HJ, Ryu KH, Choi BH, Moon JI, Kim TB, and al. Clinical Feasibility of Zero TE Skull MRI in Patients with Head Trauma in Comparison with CT: A Single-Center Study. AJNR. 2019;40(1):109‑15.
  • Lei Z, Wu S, Zhang Z, Han Y, Wang J, Li F, Shu K. Clinical characteristics, imaging finding and surgical outcomes of Chiari malformation type I in pediatric and adult patients. Current Medical Science. 2018;38(2):289-95.
  • Tubbs RS, McGirt MJ, Oakes WJ. Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg. 2003; 99:291-5.
  • Caldarelli M, Novegno F, Massimi L, Romani R, Tamburrini G, Di Rocco C. The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation Type I: experience with a pediatric series. Journal of Neurosurgery: Pediatrics. 2007;106(3):187-95.
  • Chartier A, Martinot A, Dhellemmes P, Vallee L, Lamblin MD, Goran C, Leclerc F. Malformation de Chiari de type I de l’enfant : modes de révélation de 34 observations. Arch Pédiatr. 2002; 8:789-96.
  • Pomeraniec J, Ksendzovsky A, Awad AJ, Fezeu F. Natural and surgical history of Chiari malformation type I in pediatric population. J Neurosurg Pediatr. 2015; 20:1-10.
  • Sanoussi S, Gamatie Y, Kelani A, Sbai C, Abarchi H. Malformations du tube neural au Niger: a propos de 387 cas en 10 ans. Médecine d’Afrique noire. 2001;48: 509-15.
  • Adeleye AO, Adeolu AA, Ogbole GI, Gandaho HJP. Persistent missed diagnosis of adult Chiari 1 malformation in a developing country: a neurosurgical case series. AJNS. 2016; 35:41-6.
  • Novegno F, Caldarelli M, Massa A, Chieffo D, Massimi L, Pettorini B, and al. The natural history of the Chiari Type I anomaly. PED. 2008;2(3):179‑87.
  • Benglis D, Covington D, Bhatia R, Bhatia S, Elhammady MS, Ragheb J, et al. Outcomes in pediatric patients with Chiari malformation Type I followed up without surgery. PED. 2011;7(4):375-9.
  • Greenlee JDW, Donovan KA, Hasan DM, Menezes AH. Chiari I Malformation in the Very Young Child: The Spectrum of Presentations and Experience in 31 Children Under Age 6 Years. PED. 2002;110(6):1212‑9.
  • Meadows J, Kraut M, Guarnieri M, Haroun RI, Carson BS. Asymptomatic Chiari type I malformations identified on magnetic resonance imaging. J Neurosurg. 2000; 92:920–6.
  • Smith BW, Strahle J, Bapuraj JR, Muraszko KM, Garton HJ, Maher CO. Distribution of cerebellar tonsil position: implications for understanding Chiari malformation. J Neurosurg. 2013; 119:812–9.
  • Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Chiari malformation type I and syrinx in children undergoing magnetic resonance imaging. J Neurosurg Pediatr. 2011; 8:205–13.
  • Lee S, Kim S-K, Lee JY, Phi JH, Cheon JE, Kim IO, and al. Comparison of clinical and radiological manifestations and surgical outcomes of pediatric Chiari I malformations in different age groups. Childs Nerv Syst. 2015;31(11):2091‑101.
  • Masson C, Colombani JM. La malformation de Chiari de type I à l’ère de l’imagerie par résonnance magnétique. Presse Med. 2005;34:1662-7.
  • Nagib MG. An approach to symptomatic children (ages 4-14 years) with Chiari type I malformation. Pediatr Neurosurg. 1994;21:31–5.
  • Nohria V, Oakes WJ. Chiari I malformation: a review of 43 patients. Pediatr Neurosurg. 1990;16:222–7.
  • Oakes WJ. Chiari malformations, hydromyelia, syringomyelia. Neurosurgery. 1996;3593–616.
  • Oakes WJ, Menezes AH, Sonntag VKH. The Chiari malformations of the child. Principles of spinal surgery. 1996;379–94.
  • Paul KS, Lye RH, Strang FA, Dutton J. Arnold-Chiari malformation: review of 71 cases. J Neurosurg. 1983;58:183–7.
  • Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ. The pediatric Chiari I malformation: a review. Childs Nerv Syst. 2007;23:1239-50.
  • Pandey S, Li L, Wan RH, Gao L, Xu W, Cui DM. A retrospective study on outcomes following posterior fossa decompression with dural splitting surgery in patients with Chiari type I malformation. Clinical Neurology and Neurosurgery. 2020;196:106035.
  • Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15:161–77.