{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:44:23Z","timestamp":1789670663345,"version":"4.0.1"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Abnormal craniocervical motion (ACCM) in the setting of pediatric Chiari type 1 and 1.5 malformation (CM-1\/1.5) is generally regarded to be uncommon. The focus of this modified Delphi study was to investigate and build consensus regarding the definition of ACCM in pediatric patients with CM-1\/1.5 and the clinical and radiographic methods to identify it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>An international group of 14 pediatric neurosurgeons with clinical and research expertise in the management of CM was asked to participate. The study focused only on ACCM in the setting of CM-1 and excluded other types of CM. An initial survey of current practices was administered, and based on these responses, a follow-up survey of potential consensus statements was distributed. Consensus was defined as \u2265 80% of participants reaching agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A final hybrid virtual\/in-person meeting was held for discussion and to generate final consensus statements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Following the final Delphi round, 22 statements reached consensus following discussion and modification of previous statements. Statements that reached consensus included the identification of patient populations that may benefit from screening, recommended imaging for screening along with useful radiographic parameters, and a consideration of trial cervical immobilization in symptomatic patients with supportive imaging. An additional modification to all statements emphasizing the focus on ACCM was agreed upon. All participants stated that they would be willing or somewhat willing to change their practices based on consensus guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In this study, an international group of pediatric neurosurgeons reached consensus on 22 expert opinion\u2013based statements regarding ACCM in pediatric patients with CM-1. Further study using a standardized approach to screening may facilitate a better understanding of the true incidence and impact of ACCM in CM-1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.peds24478","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T21:58:07Z","timestamp":1741384687000},"page":"486-496","source":"Crossref","is-referenced-by-count":3,"title":["Building consensus regarding the definition of abnormal craniocervical motion in pediatric patients with Chiari malformation: a modified Delphi study"],"prefix":"10.3171","volume":"35","author":[{"given":"Nikita G.","family":"Alexiades","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Arizona\u2013Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela I.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Bergen County Academies, Hackensack, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"D\u2019Ambrosio","sequence":"additional","affiliation":[{"name":"Northern Highlands Regional High School, Allendale, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Iyer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David F.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Bonfield","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandip","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Park Clinic, Kolkata, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G.","family":"Ellenbogen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Washington\/Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Grabb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C.","family":"Hankinson","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Children\u2019s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Oklahoma, Oklahoma City, Oklahoma;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"Limbrick","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cormac","family":"Maher","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Stanford University, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Connecticut Children\u2019s Hospital, Hartford, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic N. P.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas L.","family":"Brockmeyer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C. E.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, New York University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"131","article-title":"Craniovertebral junction instability in the setting of Chiari malformation","volume":"34","author":"Dastagirzada YM","year":"2023","unstructured":"Dastagirzada YM, Kurland DB, Hankinson TC, Anderson RC. Craniovertebral junction instability in the setting of Chiari malformation. Neurosurg Clin N Am. 2023;34(1):131\u2013142."},{"issue":"1","key":"b2","series-title":"J Neurosurg Spine","first-page":"1","article-title":"Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia","volume":"9","author":"Fenoy AJ","year":"2008","unstructured":"Fenoy AJ, Menezes AH, Fenoy KA. Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia. J Neurosurg Spine. 2008;9(1):1\u20139."},{"issue":"2","key":"b3","series-title":"Neurosurgery","first-page":"332","article-title":"Occipital-cervical fusion and ventral decompression in the surgical management of Chiari-1 malformation and syringomyelia: analysis of data from the Park-Reeves Syringomyelia Research Consortium","volume":"88","author":"CreveCoeur TS","year":"2021","unstructured":"CreveCoeur TS, Yahanda AT, Maher CO,  Occipital-cervical fusion and ventral decompression in the surgical management of Chiari-1 malformation and syringomyelia: analysis of data from the Park-Reeves Syringomyelia Research Consortium. Neurosurgery. 2021;88(2):332\u2013341."},{"issue":"2","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"134","article-title":"Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion","volume":"10","author":"Bollo RJ","year":"2012","unstructured":"Bollo RJ, Riva-Cambrin J, Brockmeyer MM, Brockmeyer DL. Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion. 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Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization. Neurosurg Rev. 2019;42(4):915\u2013936."},{"issue":"10","key":"b11","series-title":"Childs Nerv Syst","first-page":"1091","article-title":"Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b)","volume":"24","author":"Menezes AH","year":"2008","unstructured":"Menezes AH, Traynelis VC. Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). 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World J Orthop. 2017;8(3):271\u2013277."},{"issue":"13","key":"b15","series-title":"Ont Health Technol Assess Ser","first-page":"1","article-title":"Positional magnetic resonance imaging for people with Ehlers-Danlos syndrome or suspected craniovertebral or cervical spine abnormalities: an evidence-based analysis","volume":"15","author":"Ontario HQ","year":"2015","unstructured":"Ontario HQ. Positional magnetic resonance imaging for people with Ehlers-Danlos syndrome or suspected craniovertebral or cervical spine abnormalities: an evidence-based analysis. Ont Health Technol Assess Ser. 2015;15(13):1\u201324."},{"issue":"1","key":"b16","series-title":"Neurosurgery","first-page":"76","article-title":"Basic biomechanics of the spine","volume":"7","author":"Panjabi MM","year":"1980","unstructured":"Panjabi MM, White AA III. Basic biomechanics of the spine. 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J Neurosurg Spine. 2008;9(1):1\u20139."},{"issue":"2","key":"b3","series-title":"Neurosurgery","first-page":"332","article-title":"Occipital-cervical fusion and ventral decompression in the surgical management of Chiari-1 malformation and syringomyelia: analysis of data from the Park-Reeves Syringomyelia Research Consortium","volume":"88","author":"CreveCoeur TS","year":"2021","unstructured":"CreveCoeur TS, Yahanda AT, Maher CO,  Occipital-cervical fusion and ventral decompression in the surgical management of Chiari-1 malformation and syringomyelia: analysis of data from the Park-Reeves Syringomyelia Research Consortium. Neurosurgery. 2021;88(2):332\u2013341."},{"issue":"2","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"134","article-title":"Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion","volume":"10","author":"Bollo RJ","year":"2012","unstructured":"Bollo RJ, Riva-Cambrin J, Brockmeyer MM, Brockmeyer DL. Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion. J Neurosurg Pediatr. 2012;10(2):134\u2013141."},{"issue":"6","key":"b5","series-title":"J Neurosurg Spine","first-page":"744","article-title":"Building consensus for the medical management of children with moderate and severe acute spinal cord injury: a modified Delphi study","volume":"38","author":"CreveCoeur TS","year":"2023","unstructured":"CreveCoeur TS, Alexiades NG, Bonfield CM,  Building consensus for the medical management of children with moderate and severe acute spinal cord injury: a modified Delphi study. J Neurosurg Spine. 2023;38(6):744\u2013757."},{"issue":"6","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"649","article-title":"Development of best practices in the utilization and implementation of pediatric cervical spine traction: a modified Delphi study","volume":"27","author":"Alexiades NG","year":"2021","unstructured":"Alexiades NG, Shao B, Braga BP,  Development of best practices in the utilization and implementation of pediatric cervical spine traction: a modified Delphi study. J Neurosurg Pediatr. 2021;27(6):649\u2013660."},{"issue":"1","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"32","article-title":"Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study","volume":"31","author":"Dastagirzada YM","year":"2022","unstructured":"Dastagirzada YM, Alexiades NG, Kurland DB,  Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study. J Neurosurg Pediatr. 2022;31(1):32\u201342."},{"issue":"2","key":"b8","series-title":"Neurol Sci","first-page":"1311","article-title":"Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document","volume":"43","author":"Massimi L","year":"2022","unstructured":"Massimi L, Peretta P, Erbetta A,  Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document. 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Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization. Neurosurg Rev. 2019;42(4):915\u2013936."},{"issue":"10","key":"b11","series-title":"Childs Nerv Syst","first-page":"1091","article-title":"Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b)","volume":"24","author":"Menezes AH","year":"2008","unstructured":"Menezes AH, Traynelis VC. Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). 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World J Orthop. 2017;8(3):271\u2013277."},{"issue":"13","key":"b15","series-title":"Ont Health Technol Assess Ser","first-page":"1","article-title":"Positional magnetic resonance imaging for people with Ehlers-Danlos syndrome or suspected craniovertebral or cervical spine abnormalities: an evidence-based analysis","volume":"15","author":"Ontario HQ","year":"2015","unstructured":"Ontario HQ. Positional magnetic resonance imaging for people with Ehlers-Danlos syndrome or suspected craniovertebral or cervical spine abnormalities: an evidence-based analysis. Ont Health Technol Assess Ser. 2015;15(13):1\u201324."},{"issue":"1","key":"b16","series-title":"Neurosurgery","first-page":"76","article-title":"Basic biomechanics of the spine","volume":"7","author":"Panjabi MM","year":"1980","unstructured":"Panjabi MM, White AA III. Basic biomechanics of the spine. 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