{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:37:16Z","timestamp":1789447036020,"version":"build-2803163510"},"reference-count":36,"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":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Foramen magnum (FM) decompression with or without duraplasty is considered a common treatment strategy for Chiari malformation type I (CM-I). The authors\u2019 objective was to determine a predictive model of risk factors for clinical and radiological worsening after CM-I surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review of electronic health records was conducted at an academic tertiary care hospital from 2001 to 2019. A multivariable Cox proportional hazards regression model was used to determine the risk factors. The Kaplan-Meier estimate was plotted to delineate outcomes based on FM size. FM was measured as the preoperative distance between the basion and opisthion and dichotomized into &lt; 34 mm and \u2265 34 mm. Syrinx was measured preoperatively and postoperatively in the craniocaudal and anteroposterior directions using a T2-weighted MRI sequence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 454 patients (231 females [50.9%]) with a median (range) age of 8.0 (0\u201318) years were included in the study. The median duration of follow-up was 21.0 months (range 3.0\u2013144.0 years). The model suggested that patients with symptoms consisting of occipital\/tussive headache (HR 4.05, 95% CI 1.34\u201312.17, p = 0.01), cranial nerve symptoms (HR 3.46, 95% CI 1.16\u201310.2, p = 0.02), and brainstem\/spinal cord symptoms (HR 3.25, 95% CI 1.01\u201311.49, p = 0.05) had higher risk, whereas those who underwent arachnoid dissection\/adhesion lysis had 75% lower likelihood (HR 0.25, 95% CI 0.10\u20130.64, p = 0.004) of clinical worsening postoperatively. Similarly, patients with evidence of brainstem\/spinal cord symptoms (HR 7.9, 95% CI 2.84\u20139.50, p = 0.03), scoliosis (HR 1.04, 95% CI 1.01\u20132.80, p = 0.04), and preoperative syrinx (HR 16.1, 95% CI 1.95\u2013132.7, p = 0.03) had significantly higher likelihood of postoperative worsening of syrinx. Patients with symptoms consisting of occipital\/tussive headache (HR 5.44, 95% CI 1.86\u201315.9, p = 0.002), cranial nerve symptoms (HR 2.80, 95% CI 1.02\u20137.68, p = 0.04), and nonspecific symptoms (HR 6.70, 95% CI 1.99\u201322.6, p = 0.002) had significantly higher likelihood, whereas patients with FM \u2265 34 mm and those who underwent arachnoid dissection\/adhesion lysis had 73% (HR 0.27, 95% CI 0.08\u20130.89, p = 0.03) and 70% (HR 0.30, 95% CI 0.12\u20130.73, p = 0.008) lower likelihood of reoperation, respectively. The Kaplan-Meier curve showed that patients with FM size \u2265 34 mm had significantly better clinical (p = 0.02) and syrinx (p = 0.03) improvement postoperatively when the tonsils were resected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These results showed that preoperative and intraoperative factors may help to provide better clinical decision-making for CM-I surgery. Patients with FM size \u2265 34 mm may have better outcomes when the tonsils are resected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2022.12.focus22630","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T10:07:02Z","timestamp":1677665222000},"page":"E7","source":"Crossref","is-referenced-by-count":3,"title":["Risk factors for clinical and radiological worsening following Chiari malformation type I surgery in the pediatric population"],"prefix":"10.3171","volume":"54","author":[{"given":"Nida","family":"Fatima","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, UT Southwestern Medical Center, Dallas;"},{"name":"Department of Neurological Surgery, Children\u2019s Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale M.","family":"Swift","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UT Southwestern Medical Center, Dallas;"},{"name":"Department of Neurological Surgery, Children\u2019s Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Y","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UT Southwestern Medical Center, Dallas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley E.","family":"Weprin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UT Southwestern Medical Center, Dallas;"},{"name":"Department of Neurological Surgery, Children\u2019s Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela V.","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UT Southwestern Medical Center, Dallas;"},{"name":"Department of Neurological Surgery, Children\u2019s Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett A.","family":"Whittemore","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UT Southwestern Medical Center, Dallas;"},{"name":"Department of Neurological Surgery, Children\u2019s Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno P.","family":"Braga","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UT Southwestern Medical Center, Dallas;"},{"name":"Department of Neurological Surgery, Children\u2019s Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","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":"2","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"208","article-title":"Trends in surgical treatment of Chiari malformation Type I in the United States","volume":"19","author":"Wilkinson DA","year":"2017","unstructured":"Wilkinson DA, Johnson K, Garton HJL, Muraszko KM, Maher CO. Trends in surgical treatment of Chiari malformation Type I in the United States. J Neurosurg Pediatr. 2017;19(2):208\u2013216. 27834622"},{"issue":"2","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"161","article-title":"Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes","volume":"15","author":"Arnautovic A","year":"2015","unstructured":"Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation Type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15(2):161\u2013177. 25479580"},{"issue":"1","key":"b4","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Treatment of Chiari type I malformation in patients with and without syringomyelia: a consecutive series of 66 cases","volume":"11","author":"Alzate JC","year":"2001","unstructured":"Alzate JC, Kothbauer KF, Jallo GI, Epstein FJ. Treatment of Chiari type I malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus. 2001;11(1):E3. 16724813"},{"issue":"1","key":"b5","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Surgical treatment of Chiari I malformation: indications and approaches","volume":"11","author":"Alden TD","year":"2001","unstructured":"Alden TD, Ojemann JG, Park TS. Surgical treatment of Chiari I malformation: indications and approaches. Neurosurg Focus. 2001;11(1):E2. 16724812"},{"issue":"2","key":"b6","series-title":"Evid Based Spine Care J","first-page":"116","article-title":"Persistent\/recurrent syringomyelia after Chiari decompression-natural history and management strategies: a systematic review","volume":"4","author":"Schuster JM","year":"2013","unstructured":"Schuster JM, Zhang F, Norvell DC, Hermsmeyer JT. Persistent\/recurrent syringomyelia after Chiari decompression-natural history and management strategies: a systematic review. 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Br J Neurosurg. 1991;5(2):141\u2013152. 1863375"},{"issue":"5-6","key":"b18","series-title":"World Neurosurg","first-page":"836","article-title":"Posterior fossa reconstruction using titanium plate for the treatment of cerebellar ptosis after decompression for Chiari malformation","volume":"81","author":"Udani V","year":"2014","unstructured":"Udani V, Holly LT, Chow D, Batzdorf U. Posterior fossa reconstruction using titanium plate for the treatment of cerebellar ptosis after decompression for Chiari malformation. World Neurosurg. 2014;81(5-6):836\u2013841. 23336987"},{"key":"b1","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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