Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation

Kevin M. Stanko, Young M. Lee, Jennifer Rios, Adela Wu, Giovanna W. Sobrinho, Jon David Weingart, Eric Jackson, Edward S. Ahn, Kaisorn L. Chaichana, George Jallo

Research output: Contribution to journalArticle

Abstract

Objective Chiari Type I malformation involves caudal displacement of the cerebellar tonsils below the foramen magnum, which obstructs normal cerebrospinal fluid flow and increases intracranial pressure. Certain aspects of its surgical treatment remain controversial. A retrospective study was conducted to assess the efficacy of tonsillar cautery on syrinx resolution among pediatric Chiari patients undergoing cervicomedullary decompression. Methods A retrospective cohort study was performed for patients 0-18 years of age who underwent surgical correction for Chiari Type I malformation with syrinx between 1995 and 2013. Basic demographic information was collected as well as data for preoperative symptoms, prior surgical history, perioperative characteristics, and postsurgical outcomes. Descriptive statistics were performed in addition to bivariate analyses. Candidate predictor variables were identified based on an association with tonsillar cautery with p <0.10. Forward stepwise likelihood ratio was used to select candidate predictors in a binary logistic regression model (Pin = 0.05, Pout = 0.10) most strongly associated with the outcome. Results A total of 171 patients with Chiari Type I malformation with syrinx were identified, and 43 underwent tonsillar cautery. Patients who underwent tonsillar cautery had 6.11 times greater odds of improvement in their syrinx (95% CI 2.57-14.49, p <0.001). There was no effect of tonsillar cautery on increased perioperative complications as well as the need for repeat decompressions. Conclusions Tonsillar cautery is safe and effective in the treatment of Chiari Type I malformation with syrinx and may decrease time to syrinx resolution after cervicomedullary decompression. Tonsillar cautery does not increase postoperative complications in pediatric Chiari Type I malformation patients.

Original languageEnglish (US)
Pages (from-to)174-181
Number of pages8
JournalJournal of Neurosurgery: Pediatrics
Volume17
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Arnold-Chiari Malformation
Cautery
Syringes
Pediatrics
Decompression
Retrospective Studies
Logistic Models
Foramen Magnum
Intracranial Hypertension
Palatine Tonsil
Cerebrospinal Fluid
Cohort Studies
History
Demography
Therapeutics

Keywords

  • Cervicomedullary decompression
  • Chiari I
  • Dural opening
  • Syringomyelia
  • Tonsillar cautery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation. / Stanko, Kevin M.; Lee, Young M.; Rios, Jennifer; Wu, Adela; Sobrinho, Giovanna W.; Weingart, Jon David; Jackson, Eric; Ahn, Edward S.; Chaichana, Kaisorn L.; Jallo, George.

In: Journal of Neurosurgery: Pediatrics, Vol. 17, No. 2, 01.02.2016, p. 174-181.

Research output: Contribution to journalArticle

Stanko, Kevin M. ; Lee, Young M. ; Rios, Jennifer ; Wu, Adela ; Sobrinho, Giovanna W. ; Weingart, Jon David ; Jackson, Eric ; Ahn, Edward S. ; Chaichana, Kaisorn L. ; Jallo, George. / Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation. In: Journal of Neurosurgery: Pediatrics. 2016 ; Vol. 17, No. 2. pp. 174-181.
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abstract = "Objective Chiari Type I malformation involves caudal displacement of the cerebellar tonsils below the foramen magnum, which obstructs normal cerebrospinal fluid flow and increases intracranial pressure. Certain aspects of its surgical treatment remain controversial. A retrospective study was conducted to assess the efficacy of tonsillar cautery on syrinx resolution among pediatric Chiari patients undergoing cervicomedullary decompression. Methods A retrospective cohort study was performed for patients 0-18 years of age who underwent surgical correction for Chiari Type I malformation with syrinx between 1995 and 2013. Basic demographic information was collected as well as data for preoperative symptoms, prior surgical history, perioperative characteristics, and postsurgical outcomes. Descriptive statistics were performed in addition to bivariate analyses. Candidate predictor variables were identified based on an association with tonsillar cautery with p <0.10. Forward stepwise likelihood ratio was used to select candidate predictors in a binary logistic regression model (Pin = 0.05, Pout = 0.10) most strongly associated with the outcome. Results A total of 171 patients with Chiari Type I malformation with syrinx were identified, and 43 underwent tonsillar cautery. Patients who underwent tonsillar cautery had 6.11 times greater odds of improvement in their syrinx (95{\%} CI 2.57-14.49, p <0.001). There was no effect of tonsillar cautery on increased perioperative complications as well as the need for repeat decompressions. Conclusions Tonsillar cautery is safe and effective in the treatment of Chiari Type I malformation with syrinx and may decrease time to syrinx resolution after cervicomedullary decompression. Tonsillar cautery does not increase postoperative complications in pediatric Chiari Type I malformation patients.",
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T1 - Improvement of syrinx resolution after tonsillar cautery in pediatric patients with Chiari Type I malformation

AU - Stanko, Kevin M.

AU - Lee, Young M.

AU - Rios, Jennifer

AU - Wu, Adela

AU - Sobrinho, Giovanna W.

AU - Weingart, Jon David

AU - Jackson, Eric

AU - Ahn, Edward S.

AU - Chaichana, Kaisorn L.

AU - Jallo, George

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N2 - Objective Chiari Type I malformation involves caudal displacement of the cerebellar tonsils below the foramen magnum, which obstructs normal cerebrospinal fluid flow and increases intracranial pressure. Certain aspects of its surgical treatment remain controversial. A retrospective study was conducted to assess the efficacy of tonsillar cautery on syrinx resolution among pediatric Chiari patients undergoing cervicomedullary decompression. Methods A retrospective cohort study was performed for patients 0-18 years of age who underwent surgical correction for Chiari Type I malformation with syrinx between 1995 and 2013. Basic demographic information was collected as well as data for preoperative symptoms, prior surgical history, perioperative characteristics, and postsurgical outcomes. Descriptive statistics were performed in addition to bivariate analyses. Candidate predictor variables were identified based on an association with tonsillar cautery with p <0.10. Forward stepwise likelihood ratio was used to select candidate predictors in a binary logistic regression model (Pin = 0.05, Pout = 0.10) most strongly associated with the outcome. Results A total of 171 patients with Chiari Type I malformation with syrinx were identified, and 43 underwent tonsillar cautery. Patients who underwent tonsillar cautery had 6.11 times greater odds of improvement in their syrinx (95% CI 2.57-14.49, p <0.001). There was no effect of tonsillar cautery on increased perioperative complications as well as the need for repeat decompressions. Conclusions Tonsillar cautery is safe and effective in the treatment of Chiari Type I malformation with syrinx and may decrease time to syrinx resolution after cervicomedullary decompression. Tonsillar cautery does not increase postoperative complications in pediatric Chiari Type I malformation patients.

AB - Objective Chiari Type I malformation involves caudal displacement of the cerebellar tonsils below the foramen magnum, which obstructs normal cerebrospinal fluid flow and increases intracranial pressure. Certain aspects of its surgical treatment remain controversial. A retrospective study was conducted to assess the efficacy of tonsillar cautery on syrinx resolution among pediatric Chiari patients undergoing cervicomedullary decompression. Methods A retrospective cohort study was performed for patients 0-18 years of age who underwent surgical correction for Chiari Type I malformation with syrinx between 1995 and 2013. Basic demographic information was collected as well as data for preoperative symptoms, prior surgical history, perioperative characteristics, and postsurgical outcomes. Descriptive statistics were performed in addition to bivariate analyses. Candidate predictor variables were identified based on an association with tonsillar cautery with p <0.10. Forward stepwise likelihood ratio was used to select candidate predictors in a binary logistic regression model (Pin = 0.05, Pout = 0.10) most strongly associated with the outcome. Results A total of 171 patients with Chiari Type I malformation with syrinx were identified, and 43 underwent tonsillar cautery. Patients who underwent tonsillar cautery had 6.11 times greater odds of improvement in their syrinx (95% CI 2.57-14.49, p <0.001). There was no effect of tonsillar cautery on increased perioperative complications as well as the need for repeat decompressions. Conclusions Tonsillar cautery is safe and effective in the treatment of Chiari Type I malformation with syrinx and may decrease time to syrinx resolution after cervicomedullary decompression. Tonsillar cautery does not increase postoperative complications in pediatric Chiari Type I malformation patients.

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KW - Dural opening

KW - Syringomyelia

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