• World Neurosurg · Oct 2021

    Complex Chiari Malformation : Proposal of a new diagnostic criteria and outcome following fusion surgery.

    • Mazhar Abbas Asghar Ali Turabi, Nupur Pruthi, Dhananjaya Bhat, and Indira Devi Bhagavatula.
    • Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India.
    • World Neurosurg. 2021 Oct 1; 154: e677-e682.

    BackgroundThe proposal of C1-C2 fusion as a better treatment option compared with foramen magnum decompression (FMD) for the treatment of Chiari 1 malformations has led to controversy. Although FMD is a time-tested treatment option, a group of patients exists who will benefit from C1-C2 fusion. We have proposed an objective system for defining complex Chiari malformations and studied the outcomes of fusion with decompression versus decompression alone for these patients.MethodsA total of 26 patients with complex Chiari malformations were identified using our criteria (any 4 of 7 clinicoradiological parameters). Of the 26 patients, 13 had undergone C1-C2 fusion with FMD and 13 had undergone FMD alone. They had also undergone pre- and postoperative clinicoradiological evaluations, and the outcomes were assessed using the Chicago Chiari outcome score.ResultsOf the 13 patients in the fusion group, 12 (92.3%) showed improvement compared with only 6 of 13 patients (46.2%) in the nonfusion group using the Chicago Chiari outcome score, a statistically significant difference (P = 0.036, χ2 test). The mean hospital length of stay was longer for the fusion group (6.15 ± 1.46 days) than for the nonfusion group (4.38 ± 2.22 days; P = 0.02).ConclusionsWe have proposed a novel set of criteria for defining complex Chiari malformations. Fusion with decompression provided better outcomes than decompression alone.Copyright © 2021 Elsevier Inc. All rights reserved.

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