Positive and negative predictors for good outcome after decompressive surgery for chiari malformation type 1 as scored on the chicago chiari outcome scale

Katherine E. Hekman, Leonardo Aliaga, David Straus, Aman Luther, Judy Chen, Ajay Sampat, David Frim

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: Posterior fossa decompression (PFD) is commonly applied as treatment for Chiari malformation type 1 (CM1), an entity which is associated with a variety of presenting symptoms but little data correlating symptoms to surgical outcome. We applied the Chicago Chiari Outcome Scale (CCOS), a novel 16-point tool for evaluating outcome, to a consecutive series of CM1 patients to identify specific factors or symptoms that predispose to a better or worse surgical outcome. Methods: A series of 167 CM1 patients who underwent initial PFD at our institution (consisting of suboccipital craniectomy, C1 laminectomy, subarachnoid exploration, and expansile autologous pericranial duraplasty) were reviewed. Pre-operative signs, symptoms, and characteristics were recorded, and odds ratios were calculated to identify significant pre-operative factors corresponding to a better or worse outcome on the CCOS. Results: Sensory deficits and peripheral neuropathy correlated with a lower score on the CCOS. Younger age at the time of surgery and, strikingly, presence of syringomyelia both correlated with a higher CCOS score. Discussion: Our results identify specific presenting factors that correlated with a better or worse outcome after CM1 decompression. These data also demonstrate that CCOS scoring allows for a rigorous comparison of outcome in different patient populations and between variable operative techniques. Application of CCOS scoring to a larger patient population undergoing a variety of operative CM1 treatments should allow for better-informed decisions regarding patient selection and treatment options for CM1.

Original languageEnglish (US)
Pages (from-to)694-700
Number of pages7
JournalNeurological Research
Volume34
Issue number7
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Fingerprint

Arnold-Chiari Malformation
Decompression
Syringomyelia
Laminectomy
Peripheral Nervous System Diseases
Patient Selection
Population
Signs and Symptoms
Therapeutics
Odds Ratio

Keywords

  • Arnold-chiari malformation type 1
  • Outcome assessment
  • Patient
  • Prognosis
  • Surgery
  • Syringomyelia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Positive and negative predictors for good outcome after decompressive surgery for chiari malformation type 1 as scored on the chicago chiari outcome scale. / Hekman, Katherine E.; Aliaga, Leonardo; Straus, David; Luther, Aman; Chen, Judy; Sampat, Ajay; Frim, David.

In: Neurological Research, Vol. 34, No. 7, 01.09.2012, p. 694-700.

Research output: Contribution to journalArticle

Hekman, Katherine E. ; Aliaga, Leonardo ; Straus, David ; Luther, Aman ; Chen, Judy ; Sampat, Ajay ; Frim, David. / Positive and negative predictors for good outcome after decompressive surgery for chiari malformation type 1 as scored on the chicago chiari outcome scale. In: Neurological Research. 2012 ; Vol. 34, No. 7. pp. 694-700.
@article{a83f3f70478e4ed5a33923b5bde19756,
title = "Positive and negative predictors for good outcome after decompressive surgery for chiari malformation type 1 as scored on the chicago chiari outcome scale",
abstract = "Objective: Posterior fossa decompression (PFD) is commonly applied as treatment for Chiari malformation type 1 (CM1), an entity which is associated with a variety of presenting symptoms but little data correlating symptoms to surgical outcome. We applied the Chicago Chiari Outcome Scale (CCOS), a novel 16-point tool for evaluating outcome, to a consecutive series of CM1 patients to identify specific factors or symptoms that predispose to a better or worse surgical outcome. Methods: A series of 167 CM1 patients who underwent initial PFD at our institution (consisting of suboccipital craniectomy, C1 laminectomy, subarachnoid exploration, and expansile autologous pericranial duraplasty) were reviewed. Pre-operative signs, symptoms, and characteristics were recorded, and odds ratios were calculated to identify significant pre-operative factors corresponding to a better or worse outcome on the CCOS. Results: Sensory deficits and peripheral neuropathy correlated with a lower score on the CCOS. Younger age at the time of surgery and, strikingly, presence of syringomyelia both correlated with a higher CCOS score. Discussion: Our results identify specific presenting factors that correlated with a better or worse outcome after CM1 decompression. These data also demonstrate that CCOS scoring allows for a rigorous comparison of outcome in different patient populations and between variable operative techniques. Application of CCOS scoring to a larger patient population undergoing a variety of operative CM1 treatments should allow for better-informed decisions regarding patient selection and treatment options for CM1.",
keywords = "Arnold-chiari malformation type 1, Outcome assessment, Patient, Prognosis, Surgery, Syringomyelia",
author = "Hekman, {Katherine E.} and Leonardo Aliaga and David Straus and Aman Luther and Judy Chen and Ajay Sampat and David Frim",
year = "2012",
month = "9",
day = "1",
doi = "10.1179/1743132812Y.0000000066",
language = "English (US)",
volume = "34",
pages = "694--700",
journal = "Neurological Research",
issn = "0161-6412",
publisher = "Maney Publishing",
number = "7",

}

TY - JOUR

T1 - Positive and negative predictors for good outcome after decompressive surgery for chiari malformation type 1 as scored on the chicago chiari outcome scale

AU - Hekman, Katherine E.

AU - Aliaga, Leonardo

AU - Straus, David

AU - Luther, Aman

AU - Chen, Judy

AU - Sampat, Ajay

AU - Frim, David

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Objective: Posterior fossa decompression (PFD) is commonly applied as treatment for Chiari malformation type 1 (CM1), an entity which is associated with a variety of presenting symptoms but little data correlating symptoms to surgical outcome. We applied the Chicago Chiari Outcome Scale (CCOS), a novel 16-point tool for evaluating outcome, to a consecutive series of CM1 patients to identify specific factors or symptoms that predispose to a better or worse surgical outcome. Methods: A series of 167 CM1 patients who underwent initial PFD at our institution (consisting of suboccipital craniectomy, C1 laminectomy, subarachnoid exploration, and expansile autologous pericranial duraplasty) were reviewed. Pre-operative signs, symptoms, and characteristics were recorded, and odds ratios were calculated to identify significant pre-operative factors corresponding to a better or worse outcome on the CCOS. Results: Sensory deficits and peripheral neuropathy correlated with a lower score on the CCOS. Younger age at the time of surgery and, strikingly, presence of syringomyelia both correlated with a higher CCOS score. Discussion: Our results identify specific presenting factors that correlated with a better or worse outcome after CM1 decompression. These data also demonstrate that CCOS scoring allows for a rigorous comparison of outcome in different patient populations and between variable operative techniques. Application of CCOS scoring to a larger patient population undergoing a variety of operative CM1 treatments should allow for better-informed decisions regarding patient selection and treatment options for CM1.

AB - Objective: Posterior fossa decompression (PFD) is commonly applied as treatment for Chiari malformation type 1 (CM1), an entity which is associated with a variety of presenting symptoms but little data correlating symptoms to surgical outcome. We applied the Chicago Chiari Outcome Scale (CCOS), a novel 16-point tool for evaluating outcome, to a consecutive series of CM1 patients to identify specific factors or symptoms that predispose to a better or worse surgical outcome. Methods: A series of 167 CM1 patients who underwent initial PFD at our institution (consisting of suboccipital craniectomy, C1 laminectomy, subarachnoid exploration, and expansile autologous pericranial duraplasty) were reviewed. Pre-operative signs, symptoms, and characteristics were recorded, and odds ratios were calculated to identify significant pre-operative factors corresponding to a better or worse outcome on the CCOS. Results: Sensory deficits and peripheral neuropathy correlated with a lower score on the CCOS. Younger age at the time of surgery and, strikingly, presence of syringomyelia both correlated with a higher CCOS score. Discussion: Our results identify specific presenting factors that correlated with a better or worse outcome after CM1 decompression. These data also demonstrate that CCOS scoring allows for a rigorous comparison of outcome in different patient populations and between variable operative techniques. Application of CCOS scoring to a larger patient population undergoing a variety of operative CM1 treatments should allow for better-informed decisions regarding patient selection and treatment options for CM1.

KW - Arnold-chiari malformation type 1

KW - Outcome assessment

KW - Patient

KW - Prognosis

KW - Surgery

KW - Syringomyelia

UR - http://www.scopus.com/inward/record.url?scp=84865117622&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865117622&partnerID=8YFLogxK

U2 - 10.1179/1743132812Y.0000000066

DO - 10.1179/1743132812Y.0000000066

M3 - Article

C2 - 22781921

AN - SCOPUS:84865117622

VL - 34

SP - 694

EP - 700

JO - Neurological Research

JF - Neurological Research

SN - 0161-6412

IS - 7

ER -