From Long Island to Birmingham: how far we have come and where we are going?
The topics concerning Chiari I Malformation (CMI) have been the subject of discussions and polarizing controversies over the course of many years. During the last decade this vibrant debate has caused a slow shift of opinions among many of the opinion leaders in the field. In order to get a detailed map of the current CMI Weltanschauung among the trendsetters, 100 recognized experts in the field, from 4 Continents, were contacted to answer an ad hoc questionnaire, as a preface to the XXIX Conference of the American Chiari and Syringomyelia Alliance Project (2017, Long Island NY). We received replies from 63 experts; 60 of the responders were neurosurgeons, with a collective surgical experience of more than 15,000 CMI cases. The questionnaire contained 90 questions and was run through the Survey Monkey platform. The first part of the Questionnaire (Questions 1-51) revolved around different CMI topics: pathophysiology, epidemiology, symptomatology, and comorbidities. The second part of the Questionnaire (Questions 52-90, with multiple choice format) focused on surgical management, surgical techniques, and professional profiles. Some surprising facts emerged from the analysis of the results of the first part of the questionnaire (pathophysiology, epidemiology, symptomatology, and comorbidities): 1) a large majority of the replies showed a high level of convergence and consensus on several topics; 2) a number of topics which had been considered controversial as recently as 10 years ago are now regarded as mainstream by many; 3) 88.5% of the responders rejected the validity of the so-called “5mm rule”. The results of this questionnaire not only gave us a current roadmap of our respective opinions and ideas about this disorder but, through the unexpected convergence of consensus about several topics, it is also giving us many building blocks to start the new redefinition and re-classification effort for this disorder.
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.