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- Title
Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases.
- Authors
Matthew McGirt; Frank Attenello; April Atiba; Giannina Garces-Ambrossi; Ghazala Datoo; Jon Weingart; Benjamin Carson; George Jallo
- Abstract
Abstract Objective Symptom recurrence remains a problem for some patients after surgical decompression for Chiari I malformation. We set out to identify variables at presentation that could identify subgroups most likely to experience incomplete symptom relief after hindbrain decompression for Chiari I malformation. Materials and methods We retrospectively reviewed the records of all pediatric patients undergoing first-time suboccipital decompression for Chiari I malformation over a 10-year period. Measured outcomes included (1) persistence or recurrence of symptoms regardless of severity and (2) need for revision decompression. Results Two hundred fifty-six children (10 5years old) underwent surgery for Chiari I malformation and were followed up for a mean of 27months. Presenting symptoms included headache in 192 (75%) patients and brainstem or cranial nerve symptoms in 68 (27%) patients. Fifty-seven (22%) patients experienced mild to moderate symptom recurrence. Nineteen (7%) patients required revision decompression for significant symptom recurrence. Headache was 70% more likely to persist or recur versus cranial nerve or brainstem symptoms (relative risk 1.70, p p Conclusion In our experience, recurrence of mild symptomatology not severe enough to justify revision surgery may occur in nearly a fifth of patients after surgery. Headache was more likely to recur than objective cranial nerve or brainstem symptoms. Increasing duration of headaches, frontal headaches, and vertigo may be more refractory symptoms of Chiari I malformation.
- Subjects
HEADACHE; CRANIAL nerves; PERIPHERAL nervous system; BRAIN stem
- Publication
Child's Nervous System, 2008, Vol 24, Issue 11, p1333
- ISSN
0256-7040
- Publication type
Article
- DOI
10.1007/s00381-008-0651-3