Background: In patients with Chiari 1.5 malformation (CM1.5), a more aggressive disease course and an increased association with craniovertebral junction (CVJ) anomalies has been suggested. The best management of this subgroup of patients is not clearly defined, also due to the lack of specific series elucidating this anomaly’s peculiar characteristics. Methods: We evaluated a series of 33 patients (25 females, 8 males; mean age at surgery: 13 years) fulfilling the criteria for Chiari 1.5 diagnosis who underwent posterior fossa decompression and duraplasty (PFDD) between 2006 and 2021. Results: Headache was present in all children, five presented central apnea, five had dysphagia, and three had rhinolalia. Syringomyelia was present in 19 (58%) children. Twenty patients (61%) showed various CVJ anomalies, but only one child presented instability requiring arthrodesis. The mean tonsil displacement below the foramen magnum was 19.9 mm (range: 12–30), without significant correlation with the severity of symptoms. Syringomyelia recurred or was unchanged in three patients, and one needed C1–C2 fixation. The headache disappeared in 28 children (84%). Arachnoid opening and tonsil coagulation or resection was necessary for 19 children (58%). Conclusions: In our pediatric CM series, the need for tonsil resection or coagulation was higher in CM1.5 children due to a more severe crowding.

Surgical Management of Chiari 1.5 in Children: A Truly Different Disease? / I.G. Vetrano, A. Barbotti, T.F. Galbiati, S. Mariani, A. Erbetta, L. Chiapparini, V. Saletti, L.G. Valentini. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 13:6(2024), pp. 1708.1-1708.10. [10.3390/jcm13061708]

Surgical Management of Chiari 1.5 in Children: A Truly Different Disease?

I.G. Vetrano
Primo
;
A. Barbotti
Secondo
;
T.F. Galbiati;
2024

Abstract

Background: In patients with Chiari 1.5 malformation (CM1.5), a more aggressive disease course and an increased association with craniovertebral junction (CVJ) anomalies has been suggested. The best management of this subgroup of patients is not clearly defined, also due to the lack of specific series elucidating this anomaly’s peculiar characteristics. Methods: We evaluated a series of 33 patients (25 females, 8 males; mean age at surgery: 13 years) fulfilling the criteria for Chiari 1.5 diagnosis who underwent posterior fossa decompression and duraplasty (PFDD) between 2006 and 2021. Results: Headache was present in all children, five presented central apnea, five had dysphagia, and three had rhinolalia. Syringomyelia was present in 19 (58%) children. Twenty patients (61%) showed various CVJ anomalies, but only one child presented instability requiring arthrodesis. The mean tonsil displacement below the foramen magnum was 19.9 mm (range: 12–30), without significant correlation with the severity of symptoms. Syringomyelia recurred or was unchanged in three patients, and one needed C1–C2 fixation. The headache disappeared in 28 children (84%). Arachnoid opening and tonsil coagulation or resection was necessary for 19 children (58%). Conclusions: In our pediatric CM series, the need for tonsil resection or coagulation was higher in CM1.5 children due to a more severe crowding.
Chiari 1.5; Chiari malformation type 1; children; craniovertebral junction; posterior fossa decompression; syringomyelia; tonsils herniation
Settore MEDS-15/A - Neurochirurgia
Settore MEDS-20/B - Neuropsichiatria infantile
Settore MEDS-22/A - Diagnostica per immagini e radioterapia
2024
Article (author)
File in questo prodotto:
File Dimensione Formato  
Surgical Management of Chiari 1.5 in Children A Truly different disease.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 1.55 MB
Formato Adobe PDF
1.55 MB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1156222
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 1
  • OpenAlex ND
social impact