• Scott C Seaman, Deifelt StreeseCarolinaCDepartment of Neurology, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA., Kenneth Manzel, Janina Kamm, Arnold H Menezes, Daniel Tranel, and Brian J Dlouhy.
• Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA.
• Neurosurgery. 2021 Nov 18; 89 (6): 1087-1096.

BackgroundChiari Malformation Type I (CM-I) is defined as cerebellar tonsil displacement more than 5 mm below the foramen magnum. This displacement can alter cerebrospinal fluid flow at the cervicomedullary junction resulting in Valsalva-induced headaches and syringomyelia and compress the brainstem resulting in bulbar symptoms. However, little is known about cognitive and psychological changes in CM-I.ObjectiveTo prospectively assess cognitive and psychological performance in CM-I and determine whether changes occur after surgical decompression.MethodsBlinded evaluators assessed symptomatic CM-I patients ages ≥18 with a battery of neuropsychological and psychological tests. Testing was conducted preoperatively and 6 to 18 mo postoperatively. Data were converted to Z-scores based on normative data, and t-tests were used to analyze pre-post changes.ResultsA total of 26 patients were included, with 19 completing both pre- and post-op cognitive assessments. All patients had resolution of Valsalva-induced headaches and there was improvement in swallowing dysfunction (P < .0001), ataxia (P = .008), and sleep apnea (P = .021). Baseline performances in visual perception and construction (z = -1.11, P = .001) and visuospatial memory (z = -0.93, P = .002) were below average. Pre-post comparisons showed that CM-I patients had stable cognitive and psychological functioning after surgery, without significant changes from preoperative levels.ConclusionCM-I patients had below average performance in visuospatial and visuoconstructional abilities preoperatively. Prospective longitudinal data following surgery demonstrated improved neurologic status without any decline in cognition or psychological functioning. Routine pre- and postoperative formal neuropsychological assessment in CM-I patients help quantify cognitive and behavioral changes associated with surgical decompression.© Congress of Neurological Surgeons 2021.

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