{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:44Z","timestamp":1778803244146,"version":"3.51.4"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,16]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Chiari malformation (CM) involves a broad disease spectrum, where rare complex CM cases can be associated with craniocervical junction (CVJ) instability and require occipitocervical fusion. However, the natural progression of CVJ alignment in the general CM type I and 1.5 populations treated with posterior fossa decompression (PFD) remains insufficiently characterized. The authors aimed to compare CVJ alignment changes in patients who underwent PFD versus patients with CM who did not undergo surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective cohort study at their institution of all patients diagnosed with CM I and 1.5 from 2000 to early 2023. Demographic, clinical, and surgical data were collected, along with preoperative and postoperative MRI measurements, including tonsillar herniation, brainstem descent, clivoaxial angle (CXA), and condylar-C2 sagittal vertical alignment (C-C2SVA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 241 patients were included, with 201 undergoing PFD and 40 managed conservatively (controls). No significant differences were observed between groups in age at diagnosis, sex, or genetic diagnoses. In the PFD group, 55% underwent duraplasty and 45% underwent bone-only decompression. Baseline craniocervical alignment measurements showed a lower CXA in the PFD group (144.4\u00b0 \u00b1 13.4\u00b0) compared to controls (148.5\u00b0 \u00b1 14.2\u00b0) (p = 0.04) but no difference in C-C2SVA. Changes over time showed a small but significant decrease in CXA at &lt; 1 year after surgery in the PFD group (\u22122.7\u00b0) compared to controls (\u22122.0\u00b0) (p = 0.008), but no differences were noted at 1\u20132 years. No differences in C-C2SVA were observed over time in either group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>PFD does not significantly impact craniocervical alignment or increase the risk of occipitocervical fusion in CM I and 1.5 patients. These findings support PFD as a safe first-line treatment, even in complex CM cases, and provide important information for patient education regarding the risks of surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.peds2521","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:06Z","timestamp":1769083206000},"page":"189-196","source":"Crossref","is-referenced-by-count":1,"title":["Natural history of craniocervical alignment in Chiari patients and the impact of posterior fossa decompression"],"prefix":"10.3171","volume":"37","author":[{"given":"Isabela","family":"Pe\u00f1a Pino","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Minnesota, Minneapolis;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flora","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Minnesota, Minneapolis;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Weiner","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Minnesota, Minneapolis;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Minnesota, Duluth;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Benson","sequence":"additional","affiliation":[{"name":"Normandale Community College, Bloomington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Minnesota, Minneapolis; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Nascene","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Sandoval-Garcia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Minnesota, Minneapolis;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Guillaume","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Minnesota, Minneapolis;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"14","key":"b1","series-title":"J Clin Med","first-page":"4626","article-title":"A critical update of the classification of Chiari and Chiari-like malformations","volume":"12","author":"Sahuquillo J","year":"2023","unstructured":"Sahuquillo J, Moncho D, Ferr\u00e9 A, L\u00f3pez-Bermeo D, Sahuquillo-Muxi A, Poca MA. A critical update of the classification of Chiari and Chiari-like malformations. J Clin Med. 2023;12(14):4626."},{"key":"b2","series-title":"StatPearls","article-title":"Arnold-Chiari malformation","author":"Hidalgo JA","year":"2023","unstructured":"Hidalgo JA, Tork CA, Varacallo M. Arnold-Chiari malformation In: StatPearls. StatPearls Publishing;2023. Accessed September 30, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431076\/"},{"issue":"1","key":"b3","series-title":"Neurosurg Clin N Am","first-page":"105","article-title":"Posterior fossa decompression with or without duraplasty for Chiari I malformation","volume":"34","author":"Yahanda AT","year":"2023","unstructured":"Yahanda AT, Limbrick DD Jr. Posterior fossa decompression with or without duraplasty for Chiari I malformation. Neurosurg Clin N Am. 2023;34(1):105\u2013111."},{"issue":"2","key":"b4","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. 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Neurosurg Clin N Am. 2023;34(1):105\u2013111."},{"issue":"2","key":"b4","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":"b5","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":"1","key":"b6","series-title":"Neurosurg Clin N Am","first-page":"143","article-title":"Complex Chiari malformations: diagnosis, evaluation, and treatment","volume":"34","author":"Ravindra VM","year":"2023","unstructured":"Ravindra VM, Brockmeyer DL. Complex Chiari malformations: diagnosis, evaluation, and treatment. 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Surg Neurol Int. 2010;1:30."},{"issue":"2","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"176","article-title":"A multicenter validation of the condylar-C2 sagittal vertical alignment in Chiari malformation type I: a study using the Park-Reeves Syringomyelia Research Consortium","volume":"28","author":"Ravindra VM","year":"2021","unstructured":"Ravindra VM, Iyer RR, Yahanda AT,  A multicenter validation of the condylar-C2 sagittal vertical alignment in Chiari malformation type I: a study using the Park-Reeves Syringomyelia Research Consortium. J Neurosurg Pediatr. 2021;28(2):176\u2013182."},{"issue":"2","key":"b10","series-title":"J Neurosurg Pediatr","first-page":"170","article-title":"Analysis and interrater reliability of pB-C2 using MRI and CT: data from the Park-Reeves Syringomyelia Research Consortium on behalf of the Pediatric Craniocervical Society","volume":"20","author":"Hankinson TC","year":"2017","unstructured":"Hankinson TC, Tuite GF, Moscoso DI,  Analysis and interrater reliability of pB-C2 using MRI and CT: data from the Park-Reeves Syringomyelia Research Consortium on behalf of the Pediatric Craniocervical Society. J Neurosurg Pediatr. 2017;20(2):170\u2013175."},{"key":"b11","series-title":"World Neurosurg","first-page":"445","article-title":"Cervical paraspinal muscle atrophy rates following laminoplasty and laminectomy with fusion for cervical spondylotic myelopathy","volume":"107","author":"Ashana AO","year":"2017","unstructured":"Ashana AO, Ajiboye RM, Sheppard WL, Sharma A, Kay AB, Holly LT. 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Neuroradiol J. 2021;34(4):348\u2013354."},{"issue":"4","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"439","article-title":"Defining the role of the condylar\u2013C2 sagittal vertical alignment in Chiari malformation type I","volume":"26","author":"Ravindra VM","year":"2020","unstructured":"Ravindra VM, Iyer RR, Awad AW, Bollo RJ, Zhu H, Brockmeyer DL. Defining the role of the condylar\u2013C2 sagittal vertical alignment in Chiari malformation type I. J Neurosurg Pediatr. 2020;26(4):439\u2013444."},{"issue":"8","key":"b15","series-title":"Eur Spine J","first-page":"3109","article-title":"Cervical kyphosis after posterior cervical laminectomy with and without fusion","volume":"33","author":"Jentzsch T","year":"2024","unstructured":"Jentzsch T, Wetzel OT, Malhotra AK,  Cervical kyphosis after posterior cervical laminectomy with and without fusion. Eur Spine J. 2024;33(8):3109\u20133116."},{"issue":"9","key":"b16","series-title":"Neurol Med Chir (Tokyo)","first-page":"541","article-title":"Clinical and neuroimaging features of Chiari type I malformations with and without associated syringomyelia","volume":"38","author":"Yamazaki Y","year":"1998","unstructured":"Yamazaki Y, Tachibana S, Takano M, Fujii K. Clinical and neuroimaging features of Chiari type I malformations with and without associated syringomyelia. Neurol Med Chir (Tokyo). 1998;38(9):541\u2013547."},{"key":"b17","series-title":"Front Surg","first-page":"1143086","article-title":"Effect of modified clivoaxial angle on surgical decision making and treatment outcomes in patients with Chiari malformation type 1","volume":"10","author":"Akyuz ME","year":"2023","unstructured":"Akyuz ME, Karadag MK, Sahin MH. Effect of modified clivoaxial angle on surgical decision making and treatment outcomes in patients with Chiari malformation type 1. Front Surg. 2023;10:1143086."},{"issue":"4","key":"b18","series-title":"J Craniovertebr Junction Spine","first-page":"240","article-title":"Impact of imaging modality, age, and gender on craniocervical junction angles in adults without structural pathology","volume":"10","author":"Hussain I","year":"2019","unstructured":"Hussain I, Winston GM, Goldberg J,  Impact of imaging modality, age, and gender on craniocervical junction angles in adults without structural pathology. J Craniovertebr Junction Spine. 2019;10(4):240\u2013246."},{"issue":"3","key":"b19","series-title":"Neurosurgery","first-page":"520","article-title":"Ventral brain stem compression in pediatric and young adult patients with Chiari I malformations","volume":"44","author":"Grabb PA","year":"1999","unstructured":"Grabb PA, Mapstone TB, Oakes WJ. Ventral brain stem compression in pediatric and young adult patients with Chiari I malformations. 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