Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data from the Park-Reeves Syringomyelia Research Consortium

Travis S. Crevecoeur; Alexander T. Yahanda; Cormac O. Maher; Gabrielle W. Johnson; Laurie L. Ackerman; P. D. David Adelson; Raheel Ahmed; Gregory W. Albert; Phillipp R. Aldana; Tord D. Alden; Richard C.E. Anderson; Lissa Baird; David F. Bauer; Karin S. Bierbrauer; Douglas L. Brockmeyer; Joshua J. Chern; Daniel E. Couture; David J. Daniels; Robert C. Dauser; Susan R. Durham; Richard G. Ellenbogen; Ramin Eskandari; Herbert E. Fuchs; Timothy M. George; Gerald A. Grant; Patrick C. Graupman; Stephanie Greene; Jeffrey P. Greenfield; Naina L. Gross; Daniel J. Guillaume; Gabe Haller; Todd C. Hankinson; Gregory G. Heuer; Mark Iantosca; Bermans J. Iskandar; Eric M. Jackson; Andrew H. Jea; James M. Johnston; Robert F. Keating; Michael P. Kelly; Nickalus Khan; Mark D. Krieger; Jeffrey R. Leonard; Francesco T. Mangano; Timothy B. Mapstone; J. Gordon McComb; Arnold H. Menezes; Michael Muhlbauer; W. Jerry Oakes; Greg Olavarria; Brent R. O'Neill; Tae Sung Park; John Ragheb; Nathan R. Selden; Manish N. Shah; Chevis Shannon; Joshua S. Shimony; Jodi Smith; Matthew D. Smyth; Scellig S.D. Stone; Jennifer M. Strahle; Mandeep S. Tamber; James C. Torner; Gerald F. Tuite; Scott D. Wait; John C. Wellons; William E. Whitehead; David D. Limbrick

doi:10.1093/neuros/nyaa460

Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data from the Park-Reeves Syringomyelia Research Consortium

Travis S. Crevecoeur, Alexander T. Yahanda, Cormac O. Maher, Gabrielle W. Johnson, Laurie L. Ackerman, P. D. David Adelson, Raheel Ahmed, Gregory W. Albert, Phillipp R. Aldana, Tord D. Alden, Richard C.E. Anderson, Lissa Baird, David F. Bauer, Karin S. Bierbrauer, Douglas L. Brockmeyer, Joshua J. Chern, Daniel E. Couture, David J. Daniels, Robert C. Dauser, Susan R. DurhamRichard G. Ellenbogen, Ramin Eskandari, Herbert E. Fuchs, Timothy M. George, Gerald A. Grant, Patrick C. Graupman, Stephanie Greene, Jeffrey P. Greenfield, Naina L. Gross, Daniel J. Guillaume, Gabe Haller, Todd C. Hankinson, Gregory G. Heuer, Mark Iantosca, Bermans J. Iskandar, Eric M. Jackson, Andrew H. Jea, James M. Johnston, Robert F. Keating, Michael P. Kelly, Nickalus Khan, Mark D. Krieger, Jeffrey R. Leonard, Francesco T. Mangano, Timothy B. Mapstone, J. Gordon McComb, Arnold H. Menezes, Michael Muhlbauer, W. Jerry Oakes, Greg Olavarria, Brent R. O'Neill, Tae Sung Park, John Ragheb, Nathan R. Selden, Manish N. Shah, Chevis Shannon, Joshua S. Shimony, Jodi Smith, Matthew D. Smyth, Scellig S.D. Stone, Jennifer M. Strahle, Mandeep S. Tamber, James C. Torner, Gerald F. Tuite, Scott D. Wait, John C. Wellons, William E. Whitehead, David D. Limbrick

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P =. 011), Klippel-Feil (2/10, P =. 015), and basilar invagination (3/12, P <. 001) were increased within the OCF group, whereas only basilar invagination (1/4, P <. 001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P =. 008) and OCF/VD (115.0 ± 11.6°, P =. 025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. CONCLUSION: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.

Original language	English (US)
Pages (from-to)	332-341
Number of pages	10
Journal	Neurosurgery
Volume	88
Issue number	2
DOIs	https://doi.org/10.1093/neuros/nyaa460
State	Published - Feb 1 2021

Keywords

Chiari malformation
Clivo-axial angle
Craniovertebral junction
Occipital-cervical fusion
Syringomyelia
Ventral brainstem compression
pB-C2

ASJC Scopus subject areas

Clinical Neurology
Surgery

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10.1093/neuros/nyaa460

Cite this

Crevecoeur, T. S., Yahanda, A. T., Maher, C. O., Johnson, G. W., Ackerman, L. L., David Adelson, P. D., Ahmed, R., Albert, G. W., Aldana, P. R., Alden, T. D., Anderson, R. C. E., Baird, L., Bauer, D. F., Bierbrauer, K. S., Brockmeyer, D. L., Chern, J. J., Couture, D. E., Daniels, D. J., Dauser, R. C., ... Limbrick, D. D. (2021). Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data from the Park-Reeves Syringomyelia Research Consortium. Neurosurgery, 88(2), 332-341. https://doi.org/10.1093/neuros/nyaa460

Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data from the Park-Reeves Syringomyelia Research Consortium. / Crevecoeur, Travis S.; Yahanda, Alexander T.; Maher, Cormac O. et al.
In: Neurosurgery, Vol. 88, No. 2, 01.02.2021, p. 332-341.

Research output: Contribution to journal › Article › peer-review

Crevecoeur, TS, Yahanda, AT, Maher, CO, Johnson, GW, Ackerman, LL, David Adelson, PD, Ahmed, R, Albert, GW, Aldana, PR, Alden, TD, Anderson, RCE, Baird, L, Bauer, DF, Bierbrauer, KS, Brockmeyer, DL, Chern, JJ, Couture, DE, Daniels, DJ, Dauser, RC, Durham, SR, Ellenbogen, RG, Eskandari, R, Fuchs, HE, George, TM, Grant, GA, Graupman, PC, Greene, S, Greenfield, JP, Gross, NL, Guillaume, DJ, Haller, G, Hankinson, TC, Heuer, GG, Iantosca, M, Iskandar, BJ, Jackson, EM, Jea, AH, Johnston, JM, Keating, RF, Kelly, MP, Khan, N, Krieger, MD, Leonard, JR, Mangano, FT, Mapstone, TB, Gordon McComb, J, Menezes, AH, Muhlbauer, M, Jerry Oakes, W, Olavarria, G, O'Neill, BR, Park, TS, Ragheb, J, Selden, NR, Shah, MN, Shannon, C, Shimony, JS, Smith, J, Smyth, MD, Stone, SSD, Strahle, JM, Tamber, MS, Torner, JC, Tuite, GF, Wait, SD, Wellons, JC, Whitehead, WE & Limbrick, DD 2021, 'Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data from the Park-Reeves Syringomyelia Research Consortium', Neurosurgery, vol. 88, no. 2, pp. 332-341. https://doi.org/10.1093/neuros/nyaa460

@article{d2c22bce3b794cc4a7ea042137901d3d,

title = "Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data from the Park-Reeves Syringomyelia Research Consortium",

abstract = "BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P =. 011), Klippel-Feil (2/10, P =. 015), and basilar invagination (3/12, P <. 001) were increased within the OCF group, whereas only basilar invagination (1/4, P <. 001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P =. 008) and OCF/VD (115.0 ± 11.6°, P =. 025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. CONCLUSION: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.",

keywords = "Chiari malformation, Clivo-axial angle, Craniovertebral junction, Occipital-cervical fusion, Syringomyelia, Ventral brainstem compression, pB-C2",

author = "Crevecoeur, {Travis S.} and Yahanda, {Alexander T.} and Maher, {Cormac O.} and Johnson, {Gabrielle W.} and Ackerman, {Laurie L.} and {David Adelson}, {P. D.} and Raheel Ahmed and Albert, {Gregory W.} and Aldana, {Phillipp R.} and Alden, {Tord D.} and Anderson, {Richard C.E.} and Lissa Baird and Bauer, {David F.} and Bierbrauer, {Karin S.} and Brockmeyer, {Douglas L.} and Chern, {Joshua J.} and Couture, {Daniel E.} and Daniels, {David J.} and Dauser, {Robert C.} and Durham, {Susan R.} and Ellenbogen, {Richard G.} and Ramin Eskandari and Fuchs, {Herbert E.} and George, {Timothy M.} and Grant, {Gerald A.} and Graupman, {Patrick C.} and Stephanie Greene and Greenfield, {Jeffrey P.} and Gross, {Naina L.} and Guillaume, {Daniel J.} and Gabe Haller and Hankinson, {Todd C.} and Heuer, {Gregory G.} and Mark Iantosca and Iskandar, {Bermans J.} and Jackson, {Eric M.} and Jea, {Andrew H.} and Johnston, {James M.} and Keating, {Robert F.} and Kelly, {Michael P.} and Nickalus Khan and Krieger, {Mark D.} and Leonard, {Jeffrey R.} and Mangano, {Francesco T.} and Mapstone, {Timothy B.} and {Gordon McComb}, J. and Menezes, {Arnold H.} and Michael Muhlbauer and {Jerry Oakes}, W. and Greg Olavarria and O'Neill, {Brent R.} and Park, {Tae Sung} and John Ragheb and Selden, {Nathan R.} and Shah, {Manish N.} and Chevis Shannon and Shimony, {Joshua S.} and Jodi Smith and Smyth, {Matthew D.} and Stone, {Scellig S.D.} and Strahle, {Jennifer M.} and Tamber, {Mandeep S.} and Torner, {James C.} and Tuite, {Gerald F.} and Wait, {Scott D.} and Wellons, {John C.} and Whitehead, {William E.} and Limbrick, {David D.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2020 by the Congress of Neurological Surgeons.",

year = "2021",

month = feb,

day = "1",

doi = "10.1093/neuros/nyaa460",

language = "English (US)",

volume = "88",

pages = "332--341",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia

T2 - Analysis of Data from the Park-Reeves Syringomyelia Research Consortium

AU - Crevecoeur, Travis S.

AU - Yahanda, Alexander T.

AU - Maher, Cormac O.

AU - Johnson, Gabrielle W.

AU - Ackerman, Laurie L.

AU - David Adelson, P. D.

AU - Ahmed, Raheel

AU - Albert, Gregory W.

AU - Aldana, Phillipp R.

AU - Alden, Tord D.

AU - Anderson, Richard C.E.

AU - Baird, Lissa

AU - Bauer, David F.

AU - Bierbrauer, Karin S.

AU - Brockmeyer, Douglas L.

AU - Chern, Joshua J.

AU - Couture, Daniel E.

AU - Daniels, David J.

AU - Dauser, Robert C.

AU - Durham, Susan R.

AU - Ellenbogen, Richard G.

AU - Eskandari, Ramin

AU - Fuchs, Herbert E.

AU - George, Timothy M.

AU - Grant, Gerald A.

AU - Graupman, Patrick C.

AU - Greene, Stephanie

AU - Greenfield, Jeffrey P.

AU - Gross, Naina L.

AU - Guillaume, Daniel J.

AU - Haller, Gabe

AU - Hankinson, Todd C.

AU - Heuer, Gregory G.

AU - Iantosca, Mark

AU - Iskandar, Bermans J.

AU - Jackson, Eric M.

AU - Jea, Andrew H.

AU - Johnston, James M.

AU - Keating, Robert F.

AU - Kelly, Michael P.

AU - Khan, Nickalus

AU - Krieger, Mark D.

AU - Leonard, Jeffrey R.

AU - Mangano, Francesco T.

AU - Mapstone, Timothy B.

AU - Gordon McComb, J.

AU - Menezes, Arnold H.

AU - Muhlbauer, Michael

AU - Jerry Oakes, W.

AU - Olavarria, Greg

AU - O'Neill, Brent R.

AU - Park, Tae Sung

AU - Ragheb, John

AU - Selden, Nathan R.

AU - Shah, Manish N.

AU - Shannon, Chevis

AU - Shimony, Joshua S.

AU - Smith, Jodi

AU - Smyth, Matthew D.

AU - Stone, Scellig S.D.

AU - Strahle, Jennifer M.

AU - Tamber, Mandeep S.

AU - Torner, James C.

AU - Tuite, Gerald F.

AU - Wait, Scott D.

AU - Wellons, John C.

AU - Whitehead, William E.

AU - Limbrick, David D.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P =. 011), Klippel-Feil (2/10, P =. 015), and basilar invagination (3/12, P <. 001) were increased within the OCF group, whereas only basilar invagination (1/4, P <. 001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P =. 008) and OCF/VD (115.0 ± 11.6°, P =. 025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. CONCLUSION: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.

AB - BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P =. 011), Klippel-Feil (2/10, P =. 015), and basilar invagination (3/12, P <. 001) were increased within the OCF group, whereas only basilar invagination (1/4, P <. 001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P =. 008) and OCF/VD (115.0 ± 11.6°, P =. 025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. CONCLUSION: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.

KW - Chiari malformation

KW - Clivo-axial angle

KW - Craniovertebral junction

KW - Occipital-cervical fusion

KW - Syringomyelia

KW - Ventral brainstem compression

KW - pB-C2

UR - http://www.scopus.com/inward/record.url?scp=85100069421&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85100069421&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyaa460

DO - 10.1093/neuros/nyaa460

M3 - Article

C2 - 33313928

AN - SCOPUS:85100069421

SN - 0148-396X

VL - 88

SP - 332

EP - 341

JO - Neurosurgery

JF - Neurosurgery

IS - 2

ER -

Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data from the Park-Reeves Syringomyelia Research Consortium

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