{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:00:31Z","timestamp":1780736431739,"version":"3.54.1"},"reference-count":34,"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 Syringomyelia (syrinx) associated with Chiari malformation type I (CM-I) is commonly managed with posterior fossa decompression, which can lead to resolution in most cases. A persistent syrinx postdecompression is therefore uncommon and challenging to address. In the setting of radiographically adequate decompression with persistent syrinx, the authors prefer placing fourth ventricular subarachnoid stents that span the craniocervical junction particularly when intraoperative observation reveals arachnoid plane scarring. The objective of this study was to evaluate the safety and efficacy of a fourth ventricle stent for CM-I\u2013associated persistent syringomyelia, assess dynamic changes in syrinx dimensions, and report stent-reduction durability, clinical outcomes, and procedure-associated complications.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a single-institution, retrospective review of patients who underwent fourth ventricular subarachnoid stent placement for persistent CM-I\u2013associated syringomyelia following a prior posterior fossa decompression. The authors\u2019 institutional Chiari database contains 600 cases with 149 decompressions for CM-I\u2013associated syringomyelia, of which 13 met criteria for inclusion. Data on patient demographics, clinical presentation and outcomes, and MRI findings were collected. The maximal syrinx diameter was estimated by calculating the area of an elliptical cross-section in the largest axial plane from preoperative, immediately postoperative, and late postoperative T2-weighted MR images.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n All 13 patients experienced a significant decrease in mean syrinx area from the preoperative to the late postoperative MRI (mean syrinx diameter 114.1 \u00b1 81.8 mm\n 2<\/jats:sup>\n vs 24.5 \u00b1 23.8 mm\n 2<\/jats:sup>\n , p < 0.001). The mean time until late postoperative MRI was 19.7 months (range 2.0\u201370.7 months). The syrinx area reduced on average by 75.0% \u00b1 23.9% at the time of the last postoperative scan. Syrinx resolution was variable, with 4 patients (30.8%) achieving near-complete resolution (> 90%, grade III reduction), 7 patients (50%) having 50%\u201390% reduction (grade II), and 2 patients (14.3%) having < 50% decrease (grade I). One patient experienced catheter migration into the left brachium pontis with an associated cyst at the tip of the catheter that decreased in size on follow-up imaging.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Placement of fourth ventricular subarachnoid stents spanning the craniocervical junction in patients with persistent CM-I\u2013associated syringomyelia after posterior fossa decompression is a safe therapeutic option and significantly reduced the mean syrinx area, with a greater reductive effect seen over longer follow-up periods.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2022.12.focus22633","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T10:07:02Z","timestamp":1677665222000},"page":"E10","source":"Crossref","is-referenced-by-count":4,"title":["Fourth ventricular subarachnoid stent for Chiari malformation type I\u2013associated persistent syringomyelia"],"prefix":"10.3171","volume":"54","author":[{"given":"Rachael K.","family":"Han","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio P.","family":"Medina","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra M.","family":"Giantini-Larsen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Chae","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Cruz","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L. A.","family":"Garton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine\/NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Pediatr Neurol","first-page":"167","article-title":"Chiari I malformation with syrinx","volume":"29","author":"Carlson MD","year":"2003","unstructured":"Carlson MD, Muraszko KM. Chiari I malformation with syrinx. Pediatr Neurol. 2003;29(2):167\u2013169. 14580664"},{"issue":"3","key":"b2","series-title":"Neurosurg Q","first-page":"220","article-title":"Chiari malformation: a review of the literature","volume":"11","author":"Meadows J","year":"2001","unstructured":"Meadows J, Guarnieri M, Miller K, Chiari malformation: a review of the literature. Neurosurg Q. 2001;11(3):220\u2013229."},{"key":"b3","series-title":"World Neurosurg","first-page":"7","article-title":"A systematic review of Chiari I malformation: techniques and outcomes","volume":"88","author":"Zhao JL","year":"2016","unstructured":"Zhao JL, Li MH, Wang CL, Meng W. A systematic review of Chiari I malformation: techniques and outcomes. World Neurosurg. 2016;88:7\u201314. 26732952"},{"issue":"2","key":"b4","series-title":"Neurosurgery","first-page":"457","article-title":"Origin of syrinx fluid in syringomyelia: a physiological study","volume":"84","author":"Heiss JD","year":"2019","unstructured":"Heiss JD, Jarvis K, Smith RK, Origin of syrinx fluid in syringomyelia: a physiological study. Neurosurgery. 2019;84(2):457\u2013468. 29618081"},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1384","article-title":"Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia","volume":"46","author":"Munshi I","year":"2000","unstructured":"Munshi I, Frim D, Stine-Reyes R, Weir BK, Hekmatpanah J, Brown F. Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia. Neurosurgery. 2000;46(6):1384\u20131390. 10834643"},{"issue":"2","key":"b6","series-title":"Pediatr Neurosurg","first-page":"108","article-title":"Effect of posterior fossa decompression for Chiari malformation-I on scoliosis","volume":"53","author":"Chotai S","year":"2018","unstructured":"Chotai S, Basem J, Gannon S, Effect of posterior fossa decompression for Chiari malformation-I on scoliosis. Pediatr Neurosurg. 2018;53(2):108\u2013115. 29298440"},{"issue":"2","key":"b7","series-title":"Clin Neurol Neurosurg","first-page":"91","article-title":"Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients","volume":"102","author":"Depreitere B","year":"2000","unstructured":"Depreitere B, Van Calenbergh F, van Loon J, Goffin J, Plets C. Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients. Clin Neurol Neurosurg. 2000;102(2):91\u201396. 10817895"},{"issue":"4","key":"b8","series-title":"Surg Neurol","first-page":"258","article-title":"Surgical management of syringomyelia\u2014current results","volume":"32","author":"Matsumoto T","year":"1989","unstructured":"Matsumoto T, Symon L. Surgical management of syringomyelia\u2014current results. Surg Neurol. 1989;32(4):258\u2013265. 2781458"},{"issue":"5","key":"b9","series-title":"Childs Nerv Syst","first-page":"349","article-title":"Surgical results of posterior fossa decompression for patients with Chiari I malformation","volume":"20","author":"Navarro R","year":"2004","unstructured":"Navarro R, Olavarria G, Seshadri R, Gonzales-Portillo G, McLone DG, Tomita T. Surgical results of posterior fossa decompression for patients with Chiari I malformation. 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Neurosurg Rev. 2012;35(4):537\u2013547. 22527628"},{"issue":"2","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"164","article-title":"Fourth ventricle stent placement for treatment of recurrent syringomyelia in patients with type I Chiari malformations","volume":"23","author":"Riordan CP","year":"2018","unstructured":"Riordan CP, Scott RM. Fourth ventricle stent placement for treatment of recurrent syringomyelia in patients with type I Chiari malformations. J Neurosurg Pediatr. 2018;23(2):164\u2013170. 30497207"},{"key":"b13","series-title":"Clin Neurosurg","first-page":"531","article-title":"Management of syringomyelia: a pathophysiological approach","volume":"30","author":"Peerless SJ","year":"1983","unstructured":"Peerless SJ, Durward QJ. Management of syringomyelia: a pathophysiological approach. 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Syrinx size and duration of symptoms predict the pace of progressive myelopathy: retrospective analysis of 103 unoperated cases with craniocervical junction malformations and syringomyelia. Clin Neurol Neurosurg. 2002;104(2):90\u201397. 11932037"},{"issue":"1","key":"b16","series-title":"J Neurosurg Pediatr","first-page":"21","article-title":"Syrinx location and size according to etiology: identification of Chiari-associated syrinx","volume":"16","author":"Strahle J","year":"2015","unstructured":"Strahle J, Muraszko KM, Garton HJL, Syrinx location and size according to etiology: identification of Chiari-associated syrinx. J Neurosurg Pediatr. 2015;16(1):21\u201329. 25837888"},{"key":"b17","series-title":"World Neurosurg","first-page":"24","article-title":"Resolution of primary or recalcitrant Chiari-associated syringomyelia requires adequate cerebrospinal fluid egress from the fourth ventricle","volume":"163","author":"Emerson SN","year":"2022","unstructured":"Emerson SN, Scott RM, Al-Mefty O. Resolution of primary or recalcitrant Chiari-associated syringomyelia requires adequate cerebrospinal fluid egress from the fourth ventricle. World Neurosurg. 2022;163:24. 35398323"},{"issue":"2","key":"b1","series-title":"Pediatr Neurol","first-page":"167","article-title":"Chiari I malformation with syrinx","volume":"29","author":"Carlson MD","year":"2003","unstructured":"Carlson MD, Muraszko KM. Chiari I malformation with syrinx. 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World Neurosurg. 2016;88:7\u201314. 26732952"},{"issue":"2","key":"b4","series-title":"Neurosurgery","first-page":"457","article-title":"Origin of syrinx fluid in syringomyelia: a physiological study","volume":"84","author":"Heiss JD","year":"2019","unstructured":"Heiss JD, Jarvis K, Smith RK, Origin of syrinx fluid in syringomyelia: a physiological study. Neurosurgery. 2019;84(2):457\u2013468. 29618081"},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1384","article-title":"Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia","volume":"46","author":"Munshi I","year":"2000","unstructured":"Munshi I, Frim D, Stine-Reyes R, Weir BK, Hekmatpanah J, Brown F. Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia. Neurosurgery. 2000;46(6):1384\u20131390. 10834643"},{"issue":"2","key":"b6","series-title":"Pediatr Neurosurg","first-page":"108","article-title":"Effect of posterior fossa decompression for Chiari malformation-I on scoliosis","volume":"53","author":"Chotai S","year":"2018","unstructured":"Chotai S, Basem J, Gannon S, Effect of posterior fossa decompression for Chiari malformation-I on scoliosis. Pediatr Neurosurg. 2018;53(2):108\u2013115. 29298440"},{"issue":"2","key":"b7","series-title":"Clin Neurol Neurosurg","first-page":"91","article-title":"Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients","volume":"102","author":"Depreitere B","year":"2000","unstructured":"Depreitere B, Van Calenbergh F, van Loon J, Goffin J, Plets C. Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients. 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Neurosurg Rev. 2012;35(4):537\u2013547. 22527628"},{"issue":"2","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"164","article-title":"Fourth ventricle stent placement for treatment of recurrent syringomyelia in patients with type I Chiari malformations","volume":"23","author":"Riordan CP","year":"2018","unstructured":"Riordan CP, Scott RM. Fourth ventricle stent placement for treatment of recurrent syringomyelia in patients with type I Chiari malformations. J Neurosurg Pediatr. 2018;23(2):164\u2013170. 30497207"},{"key":"b13","series-title":"Clin Neurosurg","first-page":"531","article-title":"Management of syringomyelia: a pathophysiological approach","volume":"30","author":"Peerless SJ","year":"1983","unstructured":"Peerless SJ, Durward QJ. Management of syringomyelia: a pathophysiological approach. 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Syrinx size and duration of symptoms predict the pace of progressive myelopathy: retrospective analysis of 103 unoperated cases with craniocervical junction malformations and syringomyelia. Clin Neurol Neurosurg. 2002;104(2):90\u201397. 11932037"},{"issue":"1","key":"b16","series-title":"J Neurosurg Pediatr","first-page":"21","article-title":"Syrinx location and size according to etiology: identification of Chiari-associated syrinx","volume":"16","author":"Strahle J","year":"2015","unstructured":"Strahle J, Muraszko KM, Garton HJL, Syrinx location and size according to etiology: identification of Chiari-associated syrinx. J Neurosurg Pediatr. 2015;16(1):21\u201329. 25837888"},{"key":"b17","series-title":"World Neurosurg","first-page":"24","article-title":"Resolution of primary or recalcitrant Chiari-associated syringomyelia requires adequate cerebrospinal fluid egress from the fourth ventricle","volume":"163","author":"Emerson SN","year":"2022","unstructured":"Emerson SN, Scott RM, Al-Mefty O. Resolution of primary or recalcitrant Chiari-associated syringomyelia requires adequate cerebrospinal fluid egress from the fourth ventricle. 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