Care for Chiari malformation type I: the role of socioeconomic disadvantage and race

2021 ◽  
pp. 1-7
Author(s):  
Syed Hassan A. Akbari ◽  
Gabriela R. Oates ◽  
Irina Gonzalez-Sigler ◽  
Anastasia A. Arynchyna ◽  
Justin McCroskey ◽  
...  
Keyword(s):  
Health Insurance ◽  
Surgical Treatment ◽  
Chiari Malformation ◽  
Socioeconomic Disadvantage ◽  
Type I ◽  
Initial Visit ◽  
Symptom Presentation ◽  
Chiari Malformation Type I ◽  
Hispanic White ◽  
White Patients

OBJECTIVE There is little research on the effect of social determinants of health on Chiari malformation type I (CM-I). The authors analyzed data on all children evaluated for CM-I at a single institution to assess how socioeconomic factors and race affect the surgical treatment of this population. METHODS Medical records of patients treated for CM-I at the authors’ institution between 1992 and 2017 were reviewed. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes for each patient were used to measure neighborhood disadvantage. Non-Hispanic White patients were compared to non-White patients and Hispanic patients of any race (grouped together as non-White in this study) in terms of insurance status, ADI, and RUCA. Patients with initially benign CM-I, defined as not having undergone surgery within 9 months of their initial visit, were then stratified by having delayed symptom presentation or not, and compared on these same measures. RESULTS The sample included 665 patients with CM-I: 82% non-Hispanic White and 18% non-White. The non-White patients were more likely to reside in disadvantaged (OR 3.4, p < 0.001) and urban (OR 4.66, p < 0.001) neighborhoods and to have public health insurance (OR 3.11, p < 0.001). More than one-quarter (29%) of patients underwent surgery. The non-White and non-Hispanic White patients had similar surgery rates (29.5% vs 28.9%, p = 0.895) at similar ages (8.8 vs 9.7 years, p = 0.406). There were no differences by race/ethnicity for symptoms at presentation. Surgical and nonsurgical patients had similar ADI scores (3.9 vs 4.2, p = 0.194), RUCA scores (2.1 vs 2.3, p = 0.252), and private health insurance rates (73.6% vs 74.2%, p = 0.878). A total of 153 patients underwent surgery within 9 months of their initial visit. The remaining 512 were deemed to have benign CM-I. Of these, 40 (7.8%) underwent decompression surgery for delayed symptom presentation. Patients with delayed symptom presentation were from less disadvantaged (ADI 3.2 vs 4.2; p = 0.025) and less rural (RUCA 1.8 vs 2.3; p = 0.023) areas than those who never underwent surgery. CONCLUSIONS Although non-White patients were more likely to be socioeconomically disadvantaged, race and socioeconomic disadvantage were not associated with undergoing surgical treatment. However, among patients with benign CM-I, those undergoing decompression for delayed symptom presentation resided in more affluent and urban areas.

Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis

2008 ◽  
Vol 2 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Susan R. Durham ◽  
Kristina Fjeld-Olenec
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Clinical Improvement ◽  
Posterior Fossa ◽  
Chiari Malformation ◽  
Meta Analysis ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Patient Age

Object Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. Methods The authors searched Medline–Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000–2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years. Results Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08–0.69) and a higher rate of cerebrospinal fluid–related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53–23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95–1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91–2.25) were noted between PFDD and PFD. Conclusions Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid–related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.

scholarly journals Autologous cervical fascia duraplasty in 123 children and adults with Chiari malformation type I: surgical technique and complications

2018 ◽  
Vol 22 (3) ◽  
pp. 297-305 ◽  
Author(s):  
Brian J. Dlouhy ◽  
Arnold H. Menezes
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Aseptic Meningitis ◽  
Chiari Malformation ◽  
Senior Author ◽  
Csf Leak ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Fascia Graft ◽  
Prospective Database

OBJECTTechniques for combined extradural and intradural decompression with expansile duraplasty for Chiari malformation type I (CM-I) have been well described, with various allogenic and autologous materials used for duraplasty. However, the approach and surgical technique used for duraplasty in our treatment of CM-I and developed by the senior author in the 1990s has not been described.METHODSA prospective database was initiated in March 2003 to denote the use of cervical fascia for duraplasty and incorporate an ongoing detailed record of complications during the surgical treatment of children and adults with CM-I with and without syringomyelia. A total of 389 surgeries for CM-I were performed on 379 patients from March 2003 to June 2016. A total of 123 posterior procedures were performed on 123 patients in which both a posterior fossa extradural and intradural decompression with duraplasty (extra-intradural) was performed. In this paper the authors describe the surgical technique for harvesting and using cervical fascia for duraplasty in the surgical treatment of CM-I and analyze and discuss complications from a prospective database spanning 2003–2016.RESULTSThe authors found that cervical fascia can be harvested in patients of all ages (2–61 years old) without difficulty, and it provides a good substitute for dura in creating an expansile duraplasty in patients with CM-I. Cervical fascia is an elastic-like material with a consistency that allows for a strong watertight closure. Harvesting the cervical fascia graft does not require any further extension of the incision superiorly or inferiorly to obtain the graft. Complications were uncommon in this study of 123 children and adults. The risk of any type of complication (aseptic meningitis, CSF leak, pseudomeningocele, infection, development of hydrocephalus, and need for ventriculoperitoneal shunt) for the 78 patients in the pediatric age group was 0%. The risk of complication in the adult group was 6.7% (1 patient with aseptic meningitis and 2 patients with CSF leak).CONCLUSIONSAutologous cervical fascia is easy to obtain in patients of all ages and provides an effective material for duraplasty in the treatment of CM-I. Complications from the combination of both an extradural and intradural decompression with autologous cervical fascia duraplasty are uncommon.

The evaluation of surgical treatment options in chiari malformation type i

2009 ◽  
Author(s):  
Ersin Erdogan ◽  
Tufan Cansever ◽  
Halil Ibrahim Secer ◽  
Caglar Temiz ◽  
Sait Sirin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Chiari Malformation ◽  
Treatment Options ◽  
Type I ◽  
Chiari Malformation Type I

scholarly journals Results of the surgical treatment in children with Chiari malformation type I

2019 ◽  
Vol 35 (10) ◽  
pp. 1911-1914 ◽  
Author(s):  
Paweł Jarski ◽  
Mikołaj Zimny ◽  
Michał Linart ◽  
Zofia Kozłowska ◽  
Marek Mandera
Keyword(s):  
Surgical Treatment ◽  
Chiari Malformation ◽  
Type I ◽  
Chiari Malformation Type I

Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome

2010 ◽  
Vol 5 (6) ◽  
pp. 554-561 ◽  
Author(s):  
Gregory W. Albert ◽  
Arnold H. Menezes ◽  
Daniel R. Hansen ◽  
Jeremy D. W. Greenlee ◽  
Stuart L. Weinstein
Keyword(s):  
Surgical Treatment ◽  
Medical Records ◽  
Chiari Malformation ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Dramatic Improvement ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Initial Symptoms ◽  
Oropharyngeal Dysfunction

Object The authors conducted a study to evaluate the unique presenting signs and symptoms of Chiari malformation Type I (CM-I) in children younger than 6 years of age and highlight the benefits of early surgical treatment in this patient population. Methods The authors reviewed the medical records of patients who presented to the neurosurgery department before their 6th birthday and subsequently underwent surgery for CM-I. They identified 39 patients who had been evaluated between 1984 and 2007 and examined the medical records for presentation, surgical intervention, and outcome. Results Children aged 0–2 years commonly presented with oropharyngeal dysfunction (77.8%). Children aged 3–5 years more frequently presented with syringomyelia (85.7%), scoliosis (38.1%), and/or headache (57.1%). All patients underwent posterior fossa craniectomy. Additionally, in many patients cervical laminectomy and/or duraplasty was performed. A few patients required transoral decompression and occipitocervical fusion. In most cases, surgery led to resolution or dramatic improvement of initial symptoms. Conclusions Early recognition and surgical treatment of CM-I in young children leads to good outcomes in the majority of patients. Additional therapies for oropharyngeal dysfunction, syringomyelia, and scoliosis can frequently be avoided.

When Is Duraplasty Required in the Surgical Treatment of Chiari Malformation Type I Based on Tonsillar Descending Grading Scale?

2011 ◽  
Vol 75 (2) ◽  
pp. 307-313 ◽  
Author(s):  
Adem Yilmaz ◽  
Ayhan Kanat ◽  
Ahmet Murat Musluman ◽  
İbrahim Çolak ◽  
Yuksel Terzi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Chiari Malformation ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Grading Scale
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