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.
F7 Chiari Malformation with or without syringomyelia prospective study: post-surgery versus conservative long-term outcome in 760 adults.
Ciaramitaro P, Ferraris M, Rosso I, Petrozzino S, Petrillo M, Valentini CM, Costa P, Ducati A, Massaro F.
A longitudinal prospective study was conducted in adults affected by Chiari I syringomyelia complex and Chiari syndrome. The purpose of the study was to evaluate the long term outcome (12-48 months) after surgery (craniocervical decompression with a synthetic patch), compared with conservative management.
Between 2010 and 2016, 760 patients (230 male, 530 female, average age 48± 16 years), affected by Chiari I malformation, with or without syringomyelia, were admitted to the Inter-regional Expertise Centre for Syringomyelia and Chiari Syndrome (CRESSC) in Turin. Chiari syndrome and Chiari I syringomyelia complex diagnoses were confirmed by clinical and neuroradiological criteria, according to standardized recommendations. Patients were prospectively evaluated, both clinically (MRC, VAS, DN4, Rankin scales) and with neuroimaging (brain and whole spinal cord, cine-mode MRI). In the clinical and neuroradiological follow-up Good Outcome Scores were calculated.
56 patients underwent surgery (15 male, 41 female), average age 47 years (range 19-72). Of these, 26 with Chiari I syringomyelia complex and 15 with Chiari syndrome enjoyed a good clinical outcome (77 and 93% respectively). A good neuroradiological outcome was achieved in all patients in both groups. Of patients treated conservatively, 12(83%) with Chiari I syringomyelia complex had a good neuroradiological outcome but cavity enlargement was seen in the remaining 17%. In the 3 conservatively managed Chiari syndrome patients neither improvement nor worsening was observed.
In this prospective, long-term study a good outcome was observed after surgical treatment, in terms of functional recovery, in 77-97% of patients with Chiari I malformation, with or without syringomyelia, following careful patient selection. The clinical and neuroradiological outcome with conservative management was also good (83%). These results need to be confirmed with longer follow up (> 5 years) and in wider cohorts of Chiari malformation patients.