{"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":1789447036024,"version":"build-2803163510"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Chiari malformation type I (CM-I) is defined by the herniation of the cerebellar tonsils into the spinal canal. When symptomatic, surgical decompression is recommended. Reported CM-I reoperation rates have ranged from 3% to 30%. However, the relationship between patient age at first surgical intervention and the likelihood of reoperation and postoperative complications remains poorly characterized. Therefore, this study aimed to determine whether patient age was associated with reoperation and complication rates.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients 0\u201321 years old with a diagnosis of CM-I and surgical decompression were queried from the 2007\u20132021 MarketScan databases. Patient sex, age at time of first procedure, comorbidities, 90-day postoperative complications, and reoperations were identified. Bootstrap-augmented binary classifiers were constructed to determine the optimal timing of first surgical decompression with respect to all-cause 90-day postoperative complications and reoperation. Multivariate logistic regression models were built to assess the relationship between age, sex, and comorbidities and the likelihood of reoperation and complications following surgical decompression.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 2675 patients were included for analysis of 90-day postoperative complications, and 1157 were included in the reoperation analysis cohort. A total of 524 patients (19.6%) experienced a complication within 90 days of surgical decompression, and 84 patients (7.3%) had reoperations. On multivariate regression, increased age was an independent predictor of a reduced likelihood of both reoperations (OR 0.94, 95% CI 0.90\u20130.98; p &lt; 0.01) and 90-day postoperative complications (OR 0.96, 95% CI 0.94\u20130.98; p &lt; 0.01). The optimal age cutoff to predict both complications and reoperations was 4 years. For patients ages 4 years and older, both the reoperation rate (5.5% vs 13.2%, p &lt; 0.01) and 90-day postoperative complication rates (18.4% vs 27.7%; p &lt; 0.01) were significantly less than those for children 3 years and younger.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In a national cohort of pediatric patients undergoing surgically managed CM-I, there was a significantly increased likelihood of reoperation and complications in patients ages 3 years and younger. Although CM-I decompression should not be postponed in the face of progressive neurological deficits, the authors\u2019 findings suggest that delaying surgery until after the age of 3 years, when medically feasible, may help mitigate adverse events.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.7.peds247","type":"journal-article","created":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T02:29:04Z","timestamp":1726885744000},"page":"619-627","source":"Crossref","is-referenced-by-count":4,"title":["Age as a predictor of reoperations and complications in surgically managed pediatric Chiari malformation type I"],"prefix":"10.3171","volume":"34","author":[{"given":"Thomas","family":"Johnstone","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Isabel","family":"Barros Guinle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura M.","family":"Prolo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald A.","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"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."},{"issue":"3 Suppl","key":"b2","series-title":"J Neurosurg","first-page":"187","article-title":"The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation Type I: experience with a pediatric series","volume":"106","author":"Caldarelli M","year":"2007","unstructured":"Caldarelli M, Novegno F, Vassimi L, Romani R, Tamburrini G, Di Rocco C. The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation Type I: experience with a pediatric series. 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J Neurosurg Pediatr. 2022;30(2):210\u2013216."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"629","article-title":"Factors associated with syrinx size in pediatric patients treated for Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium","volume":"25","author":"Hale AT","year":"2020","unstructured":"Hale AT, Adelson PD, Albert GW,  Factors associated with syrinx size in pediatric patients treated for Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium. 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Part 1: validation of an ICD-9-CM code search algorithm","volume":"17","author":"Ladner TR","year":"2016","unstructured":"Ladner TR, Greenberg JK, Guerrero N,  Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm. J Neurosurg Pediatr. 2016;17(5):519\u2013524."},{"issue":"5","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"525","article-title":"Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York","volume":"17","author":"Greenberg JK","year":"2016","unstructured":"Greenberg JK, Olsen MA, Yarbrough CK,  Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York. 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Neurosurg Focus. 2023;54(3):E9."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/6\/article-p619.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/6\/article-p619.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/6\/article-p619.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:09:29Z","timestamp":1733490569000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/6\/article-p619.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":18,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2024.7.peds247","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}