{"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":1789447036085,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"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>Background: In patients with Chiari 1.5 malformation (CM1.5), a more aggressive disease course and an increased association with craniovertebral junction (CVJ) anomalies has been suggested. The best management of this subgroup of patients is not clearly defined, also due to the lack of specific series elucidating this anomaly\u2019s peculiar characteristics. Methods: We evaluated a series of 33 patients (25 females, 8 males; mean age at surgery: 13 years) fulfilling the criteria for Chiari 1.5 diagnosis who underwent posterior fossa decompression and duraplasty (PFDD) between 2006 and 2021. Results: Headache was present in all children, five presented central apnea, five had dysphagia, and three had rhinolalia. Syringomyelia was present in 19 (58%) children. Twenty patients (61%) showed various CVJ anomalies, but only one child presented instability requiring arthrodesis. The mean tonsil displacement below the foramen magnum was 19.9 mm (range: 12\u201330), without significant correlation with the severity of symptoms. Syringomyelia recurred or was unchanged in three patients, and one needed C1\u2013C2 fixation. The headache disappeared in 28 children (84%). Arachnoid opening and tonsil coagulation or resection was necessary for 19 children (58%). Conclusions: In our pediatric CM series, the need for tonsil resection or coagulation was higher in CM1.5 children due to a more severe crowding.<\/jats:p>","DOI":"10.3390\/jcm13061708","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T14:05:25Z","timestamp":1710511525000},"page":"1708","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical Management of Chiari 1.5 in Children: A Truly Different Disease?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0664-9700","authenticated-orcid":false,"given":"Ignazio G.","family":"Vetrano","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"},{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Barbotti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso Francesco","family":"Galbiati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1634-9445","authenticated-orcid":false,"given":"Sabrina","family":"Mariani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3155-4850","authenticated-orcid":false,"given":"Alessandra","family":"Erbetta","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8115-9897","authenticated-orcid":false,"given":"Luisa","family":"Chiapparini","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology and Neuroradiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Saletti","sequence":"additional","affiliation":[{"name":"Developmental Neurology Unit, Mariani Foundation Center Foizr Complex Disabilities, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura G.","family":"Valentini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1007\/s00381-019-04172-6","article-title":"Defining, Diagnosing, Clarifying, and Classifying the Chiari I Malformations","volume":"35","author":"Bordes","year":"2019","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1055\/s-0029-1206803","article-title":"Ueber Ver\u00e4nderungen Des Kleinhirns Infolge von Hydrocephalie Des Grosshirns","volume":"17","author":"Chiari","year":"1891","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_3","first-page":"71","article-title":"Uber Veranderungen Des Kleinhirns, Des Pons Und Der Medulla Oblongata Infolge von Congenitaler Hydrocephalie Des Grosshirns","volume":"63","author":"Chiari","year":"1896","journal-title":"Denkschr. Kais. Akad. Wiss. Math.-Naturw."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3171\/2011.5.PEDS1121","article-title":"Chiari Malformation Type I and Syrinx in Children Undergoing Magnetic Resonance Imaging: Clinical Article","volume":"8","author":"Strahle","year":"2011","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.nec.2015.06.004","article-title":"Clinical Presentation of Chiari I Malformation and Syringomyelia in Children","volume":"26","author":"Pindrik","year":"2015","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s10072-017-2950-5","article-title":"Chiari Malformation-Related Headache: Outcome after Surgical Treatment","volume":"38","author":"Beretta","year":"2017","journal-title":"Neurol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Shen, J., Shen, J., Huang, K., Wu, Y., Pan, J., and Zhan, R. (2019). Syringobulbia in Patients with Chiari Malformation Type I: A Systematic Review. Biomed. Res. Int., 2019.","DOI":"10.1155\/2019\/4829102"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"371","DOI":"10.5664\/jcsm.2592","article-title":"Sleep Disordered Breathing in Children and Adolescents with Chiari Malformation Type I","volume":"9","author":"Losurdo","year":"2013","journal-title":"J. Clin. Sleep Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1007\/s00381-017-3399-9","article-title":"Evaluation of the Central Sleep Apnea in Asymptomatic Children with Chiari 1 Malformation: An Open Question","volume":"33","author":"Zaffanello","year":"2017","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1155\/2015\/831569","article-title":"The Association between Sleep-Disordered Breathing and Magnetic Resonance Imaging Findings in a Pediatric Cohort with Chiari 1 Malformation","volume":"22","author":"Amin","year":"2015","journal-title":"Can. Respir. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"940","DOI":"10.4103\/0028-3886.236992","article-title":"Basilar Invagination, Syringomyelia and Chiari Formation and Their Relationship with Atlantoaxial Instability","volume":"66","author":"Goel","year":"2018","journal-title":"Neurol. India"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/978-3-319-62515-7_15","article-title":"Atlantoaxial Fixation for Treatment of Chiari Formation and Syringomyelia with No Craniovertebral Bone Anomaly: Report of an Experience with 57 Cases","volume":"125","author":"Goel","year":"2019","journal-title":"Acta Neurochir. Suppl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1007\/s00381-019-04284-z","article-title":"Chiari Malformation and Atlantoaxial Instability: Problems of Co-Existence","volume":"35","author":"Chatterjee","year":"2019","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1007\/s00381-019-04214-z","article-title":"Complex Chiari Malformation: Using Craniovertebral Junction Metrics to Guide Treatment","volume":"35","author":"Ho","year":"2019","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1007\/s10072-021-05317-9","article-title":"Diagnosis and Treatment of Chiari Malformation Type 1 in Children: The International Consensus Document","volume":"43","author":"Massimi","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"375","DOI":"10.3340\/jkns.2010.48.4.375","article-title":"Chiari 1.5 Malformation: An Advanced Form of Chiari I Malformation","volume":"48","author":"Kim","year":"2010","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_17","first-page":"179","article-title":"A Critical Analysis of the Chiari 1.5 Malformation","volume":"101","author":"Tubbs","year":"2004","journal-title":"J. Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1007\/s10072-021-05347-3","article-title":"Diagnosis and Treatment of Chiari Malformation and Syringomyelia in Adults: International Consensus Document","volume":"43","author":"Ciaramitaro","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"452","DOI":"10.3171\/2020.8.PEDS20462","article-title":"The Relationship between Chiari 1.5 Malformation and Sleep-Related Breathing Disorders on Polysomnography","volume":"27","author":"Sader","year":"2021","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1080\/01616412.2021.1934314","article-title":"Long-Term Outcomes of Surgical Management in Subtypes of Chiari Malformation","volume":"43","author":"Basaran","year":"2021","journal-title":"Neurol. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1007\/s00381-008-0606-8","article-title":"Anatomy and Biomechanics of Normal Craniovertebral Junction (a) and Biomechanics of Stabilization (b)","volume":"24","author":"Menezes","year":"2008","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3171\/2022.4.PEDS21410","article-title":"Chiari Malformation Type I Surgery in Children: French Multicenter 10-Year Cohort","volume":"30","author":"Mazerand","year":"2022","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2176\/nmc.ra.2017-0032","article-title":"Pediatric Craniovertebral Junction Surgery","volume":"57","author":"Morota","year":"2017","journal-title":"Neurol. Med. Chir."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"134","DOI":"10.3171\/2012.3.PEDS11340","article-title":"Complex Chiari Malformations in Children: An Analysis of Preoperative Risk Factors for Occipitocervical Fusion","volume":"10","author":"Bollo","year":"2012","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e921","DOI":"10.1016\/j.wneu.2020.06.076","article-title":"Chiari 1 Formation Redefined\u2014Clinical and Radiographic Observations in 388 Surgically Treated Patients","volume":"141","author":"Goel","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"195","DOI":"10.14245\/ns.1938192.096","article-title":"Is Cervical Stabilization for All Cases of Chiari-I Malformation an Overkill? Evidence Speaks Louder Than Words!","volume":"16","author":"Deora","year":"2019","journal-title":"Neurospine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/6\/1708\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:14:32Z","timestamp":1760105672000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/6\/1708"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,15]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["jcm13061708"],"URL":"https:\/\/doi.org\/10.3390\/jcm13061708","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,15]]}}}