{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:47:23Z","timestamp":1789670843898,"version":"4.0.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The Chicago Chiari Outcome Scale (CCOS) serves as a standardized clinical outcome evaluation tool among patients with Chiari malformation type I (CM-I). While the reliability of this scale has been proven for pediatric patients, the literature lacks CCOS validation when used solely in adults. Therefore, this study aimed to determine the validity of the CCOS in an external cohort of adult patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively analyzed the medical records of symptomatic patients with CM-I who underwent posterior fossa decompression between 2010 and 2018 in six neurosurgical departments. Each patient was clinically assessed at the latest available follow-up. Gestalt outcome was determined as improved, unchanged, or worsened compared with the preoperative clinical state. Additionally, the CCOS score was calculated for each patient based on the detailed clinical data. To verify the ability of the CCOS to determine clinical improvement, the area under the receiver operating characteristic (AUROC) curve was evaluated. A logistic regression analysis using all four components of the CCOS (pain symptoms, nonpain symptoms, functionality, and complications) was performed to establish predictors of the improved outcome.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Seventy-five individuals with a mean age of 42 \u00b1 15.32 years were included in the study. The mean follow-up duration was 52 \u00b1 33.83 months. Considering gestalt outcome evaluation, 41 patients (54.7%) were classified as improved, 24 (32%) as unchanged, and 10 (13.3%) as worsened. All patients with a CCOS score of 14 or higher improved, while all those with a CCOS score of 8 or lower worsened. The AUROC was 0.986, suggesting almost perfect accuracy of the CCOS in delineating clinical improvement. A CCOS score of 13 showed high sensitivity (0.93) and specificity (0.97) for identifying patients with clinical improvement. Additionally, a meaningful correlation was found between higher CCOS scores in each component and better outcomes. Patient stratification by total CCOS score showed that those categorized as improved, unchanged, and worsened scored prevalently between 13 and 16 points, 10 and 12 points, and 4 and 9 points, respectively.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In this adult cohort, the CCOS was found to be almost perfectly accurate in reflecting postoperative clinical improvement. Moreover, all four CCOS components (pain symptoms, nonpain symptoms, functionality, and complications) significantly correlated with patient clinical outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2022.12.focus22625","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T10:07:02Z","timestamp":1677665222000},"page":"E3","source":"Crossref","is-referenced-by-count":15,"title":["External validation of the Chicago Chiari Outcome Scale in adults with Chiari malformation type I"],"prefix":"10.3171","volume":"54","author":[{"given":"Lukasz","family":"Antkowiak","sequence":"first","affiliation":[{"name":"Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Stogowski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Copernicus Medical Center, Gdansk, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Klepinowski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan","family":"Balinski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert","family":"Mado","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Sumislawski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Niedbala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Silesia in Katowice, Regional Hospital, Sosnowiec, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michalina","family":"Rucinska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuzanna","family":"Nowaczyk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Rogalska","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical University of Warsaw, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian","family":"Kocur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kasperczuk","sequence":"additional","affiliation":[{"name":"Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, Bialystok, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryszard","family":"Sordyl","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Kloc","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Copernicus Medical Center, Gdansk, Poland;"},{"name":"Department of Psychology and Sociology of Health and Public Health, School of Public Health, Collegium Medicum, University of Warmia\u2013Mazury in Olsztyn, Poland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Kaspera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Silesia in Katowice, Regional Hospital, Sosnowiec, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrud","family":"Kammler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leszek","family":"Sagan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland;"},{"name":"Department of Pediatric Neurosurgery, Zdroje Hospital, Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Rudnik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawel","family":"Tabakow","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Westphal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Mandera","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"217","article-title":"The Chiari I malformation","volume":"24","author":"McClugage SG","year":"2019","unstructured":"McClugage SG, Oakes WJ. The Chiari I malformation. J Neurosurg Pediatr. 2019;24(3):217\u2013226. 31473667"},{"key":"b2","series-title":"World Neurosurg","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg. 2017;104:213\u2013219. 28435116"},{"issue":"3","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"248","article-title":"Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I","volume":"7","author":"Tubbs RS","year":"2011","unstructured":"Tubbs RS, Beckman J, Naftel RP, Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J Neurosurg Pediatr. 2011;7(3):248\u2013256. 21361762"},{"issue":"3","key":"b4","series-title":"Neurosurgery","first-page":"279","article-title":"The Chiari Severity Index: a preoperative grading system for Chiari malformation type 1","volume":"76","author":"Greenberg JK","year":"2015","unstructured":"Greenberg JK, Yarbrough CK, Radmanesh A, The Chiari Severity Index: a preoperative grading system for Chiari malformation type 1. Neurosurgery. 2015;76(3):279\u2013285. 25584956"},{"issue":"4","key":"b5","series-title":"Disabil Health J","first-page":"521","article-title":"The impact of Chiari malformation on daily activities: a report from the national Conquer Chiari Patient Registry database","volume":"8","author":"Meeker J","year":"2015","unstructured":"Meeker J, Amerine J, Kropp D, Chyatte M, Fischbein R. The impact of Chiari malformation on daily activities: a report from the national Conquer Chiari Patient Registry database. 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Med Care. 1996;34(3):220\u2013233. 8628042"},{"issue":"5","key":"b10","series-title":"Neurosurgery","first-page":"820","article-title":"Accurately measuring outcomes after surgery for adult Chiari I malformation: determining the most valid and responsive instruments","volume":"72","author":"Godil SS","year":"2013","unstructured":"Godil SS, Parker SL, Zuckerman SL, Mendenhall SK, McGirt MJ. Accurately measuring outcomes after surgery for adult Chiari I malformation: determining the most valid and responsive instruments. Neurosurgery. 2013;72(5):820\u2013827. 23381490"},{"issue":"3","key":"b11","series-title":"Neurosurgery","first-page":"656","article-title":"A novel scoring system for assessing Chiari malformation type I treatment outcomes","volume":"70","author":"Aliaga L","year":"2012","unstructured":"Aliaga L, Hekman KE, Yassari R, A novel scoring system for assessing Chiari malformation type I treatment outcomes. 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Neurol Res. 2012;34(7):694\u2013700. 22781921"},{"issue":"3","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"217","article-title":"The Chiari I malformation","volume":"24","author":"McClugage SG","year":"2019","unstructured":"McClugage SG, Oakes WJ. The Chiari I malformation. J Neurosurg Pediatr. 2019;24(3):217\u2013226. 31473667"},{"key":"b2","series-title":"World Neurosurg","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. 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Neurosurgery. 2015;76(3):279\u2013285. 25584956"},{"issue":"4","key":"b5","series-title":"Disabil Health J","first-page":"521","article-title":"The impact of Chiari malformation on daily activities: a report from the national Conquer Chiari Patient Registry database","volume":"8","author":"Meeker J","year":"2015","unstructured":"Meeker J, Amerine J, Kropp D, Chyatte M, Fischbein R. The impact of Chiari malformation on daily activities: a report from the national Conquer Chiari Patient Registry database. Disabil Health J. 2015;8(4):521\u2013526. 25753308"},{"issue":"7","key":"b6","series-title":"J Manipulative Physiol Ther","first-page":"409","article-title":"The Neck Disability Index: a study of reliability and validity","volume":"14","author":"Vernon H","year":"1991","unstructured":"Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. 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