how to predict the surgical result in pediatric chiari malformations

1. Chronic tonsillar herniation:
pre and postoperative
assessment using a semi-
quantitative approach.
M Vinchon, M-A Karnoub
Lille France
Tiepolo, Vincenza: the augur Calchas
neurochirurgiepediatrique.com

2. material and methods: patients selected for
posterior fossa decompression
• clinics preop, 3 months, 1 year
• scale 0/1/2
• absent
• compatible
• suggestive
• headache
• apneas
• reflexes
• neurological signs
• digestive
• spinal
• cognitive
• preop @ postop MRI
• scale 0/1/2
• none
• mild
• important
• tonsillar prolapse
• pointed tonsils
• deformed medulla
• edema medulla
• syrinx
• surgical findings
• scale 0/1/2
• foramen crowding
• arachnoiditis
• duraplasty
• W/Wo tonsillar
resection
0
1
2

3. results: 42 patients operated 4/2018 to 8/2020
0
5
10
15
20
25
30
35
40
45
neck pain apnoeas reflexes neuro digestive spine cognition
signs and symptoms at presentation
suggestive consistent none
0
5
10
15
20
25
30
35
40
45
neck pain apneas reflexes neuro digestive spine cognition
signs and symptoms at last control
suggestive consistent none
0
5
10
15
20
25
30
35
40
45
low tonsils pointed tonsils deformed medulla edema syrinx
preoperative imaging
important present none
0
5
10
15
20
25
30
35
40
45
low tonsils pointed tonsils deformed
medulla
edema syrinx
postoperative MRI
important present none
0
1
2

4. predictive value in multivariate analysis
Category Variable Final clinical score Improvement
Preoperative clinical Total score 0.000 0.004
sleep apneas 0.008 NS
Abnormal reflexes 0.028 NS
Spinal deformity 0.005 NS
Preoperative radiological Total score NS 0.024
syrinx 0.025 NS
Postoperative radiological Total score NS 0.015

5. conclusion
• semi-quantitative evaluation of clinical and
radiological features
• inspired by script concordance test
• clinical and radiological scores
• postoperative outcome is best predicted by
clinical presentation, not imaging
• poorer outcome when symptomatic syrinx
Rome, Capitole museum