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

25 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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