The symposium is co-organised by The Ann Conroy Trust, in association with Aesculap Academia.
The Ann Conroy Trust is Registered Charity No: 1165808.
We provide Support, Education and Research for patients living with Chiari Malformation, Syringomyelia and associated conditions.
F22 Chiari I malformation: should we operate on pictures or children? Proposal of a diagnostic and therapeutic flow chart based on the retrospective analysis of 630 mono-institutional cases.
Valentini L, Saletti V, Chiapparini L, Babini M, Furlanetto M.
Many discussions about treatment for Chiari I Malformation (CM1) and syringomyelia in children centre both on indications and surgical technique. Complex Chiari is reported to need craniovertebral stabilization in as many as 50% of cases. The present review aimed to evaluate the results of craniovertebral decompression, with or without duraplasty and/or tonsillar resection, in a series of 150 operated children, focusing on the association with tethered cord and craniovertebral instability.
171 children were operated for CM at the National Neurological Institute of Milan (FINCB) between 1986 and 2018. Their ages at surgery ranged from 1 up to 17 years. Preoperative MR was performed in every case and included the whole neuraxis, to rule out associated malformations. In 70% of cases symptoms before surgery were due to associated syringomyelia. A group of 459 symptomatic children were also followed, for a mean time of 5 years.
Only 20 asymptomatic children required surgery, despite pronounced tonsillar descent being present in many cases. In 22 cases upward migration of the tonsils was seen to occur over time. In the surgical group, pre-operative symptoms related to CM1 improved. Syringomyelia reduced in more than 80% of children and disappeared in a significant number. There was no major surgical morbidity and no mortality. Often, however, re-operation for tonsil resection was needed. Association with tethered cord was rare (2%). Craniovertebral junction malformations submitted to dynamic CT or MRI displayed mild instability in few patients but none has required fixation.
In children clinical symptoms are often more serious than in adults but surgical results may be better. True clinical and MRI instability requiring fixation is very rare. Asymptomatic children have a low risk of going on to develop symptoms.