{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:01:43Z","timestamp":1790816503742,"version":"4.1.0"},"reference-count":10,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T00:00:00Z","timestamp":1654819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Revision surgery after posterior fossa decompression for Chiari malformation is not uncommon and poses both strategic and technical challenges. We conducted a single-center retrospective cohort study including all adult patients who underwent revision surgery after posterior fossa decompression for Chiari type I malformation between 2010 and 2019. Among 311 consecutive patients operated on for Chiari malformation at our institution, 35 patients had a least one revision surgery with a mean follow-up of 70.2 months. Mean delay for revision was 28.8 months. First revision surgery was performed at the level of the foramen magnum in 25\/35 cases and consisted in duraplasty revision in all cases, arachnolysis (51.4%), additional bone decompression (37.1%), tonsillar coagulation or resection (25.7%), 4th ventricle to cervical subarachnoid spaces shunt (5.7%). Most repeat revisions consisted in CSF diversion procedures, with either ventriculo-peritoneal or syringo-peritoneal shunts. Mean number of interventions per patient was 3.2, with 22.9% of patients undergoing 4 or more surgeries. Based on our experience, we propose that revision at the level of the foramen magnum should be considered as a first-line strategy for Chiari decompression failure. Shunting procedures can be performed in case of extensive arachnoiditis or repeated failures.<\/jats:p>","DOI":"10.3390\/jcm11123334","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T10:25:12Z","timestamp":1654856712000},"page":"3334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Surgical Management after Chiari Decompression Failure: Craniovertebral Junction Revision versus Shunting Strategies"],"prefix":"10.3390","volume":"11","author":[{"given":"Steven","family":"Knafo","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Bic\u00eatre Hospital, AP-HP, University Paris-Saclay, 94270 Le Kremlin-Bic\u00eatre, France"},{"name":"C-MAVEM National Reference Center for Rare Diseases (Chiari, Syringomyelia and Vertebromedullary Malformations), 94270 Le Kremlin-Bic\u00eatre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Malcoci","sequence":"additional","affiliation":[{"name":"Departement of Neurosurgery, Mondor Hospital, AP-HP, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Morar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bic\u00eatre Hospital, AP-HP, University Paris-Saclay, 94270 Le Kremlin-Bic\u00eatre, France"},{"name":"C-MAVEM National Reference Center for Rare Diseases (Chiari, Syringomyelia and Vertebromedullary Malformations), 94270 Le Kremlin-Bic\u00eatre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bic\u00eatre Hospital, AP-HP, University Paris-Saclay, 94270 Le Kremlin-Bic\u00eatre, France"},{"name":"C-MAVEM National Reference Center for Rare Diseases (Chiari, Syringomyelia and Vertebromedullary Malformations), 94270 Le Kremlin-Bic\u00eatre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nozar","family":"Aghakhani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Bic\u00eatre Hospital, AP-HP, University Paris-Saclay, 94270 Le Kremlin-Bic\u00eatre, France"},{"name":"C-MAVEM National Reference Center for Rare Diseases (Chiari, Syringomyelia and Vertebromedullary Malformations), 94270 Le Kremlin-Bic\u00eatre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1227\/01.NEU.0000336768.95044.80","article-title":"Long-term follow-up of Chiari-related syringomyelia in adults: Analysis of 157 surgically treated cases","volume":"64","author":"Aghakhani","year":"2009","journal-title":"Neurosurgery"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1227\/NEU.0b013e31825c3426","article-title":"Surgical Treatment of Chiari I Malformation\u2014Analysis of Intraoperative Findings, Complications, and Outcome for 371 Foramen Magnum Decompressions","volume":"71","author":"Klekamp","year":"2012","journal-title":"Neurosurgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e490","DOI":"10.1016\/j.wneu.2018.04.077","article-title":"Adult Chiari I Malformations: An Analysis of Surgical Risk Factors and Complications Using an International Database","volume":"115","author":"Bhimani","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1055\/s-0033-1357362","article-title":"Persistent\/Recurrent Syringomyelia after Chiari Decompression? Natural History and Management Strategies: A Systematic Review","volume":"4","author":"Schuster","year":"2013","journal-title":"Evid.-Based Spine-Care J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.wneu.2020.01.148","article-title":"Persistent Syringomyelia After Posterior Fossa Decompression for Chiari Malformation","volume":"136","author":"Tosi","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/foc.2003.15.3.3","article-title":"Revision surgery for chiari malformation decompression","volume":"15","author":"Mazzola","year":"2003","journal-title":"Neurosurg. 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