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Purpose <p>To assess surgical outcome of pediatric patients undergoing foramen magnum decompression (FMD) with multiple superficial dural incisions (MSDI) in Chiari I malformation (CM I), with or without syringomyelia.</p> Methods <p>A retrospective review of 91 pediatric patients who underwent FMD with MSDI technique between 2010 and 2024 at three tertiary neurosurgical centers.</p> Results <p>Median age at surgery was 10&#xa0;years (range 1–18). 57% were female. Preoperative symptoms included headaches/neck pain (55%), neurological deficits (44%), dysphagia (13%), snoring (18%), and cranial nerve involvement (12%). Syringomyelia was present in 48 patients (53%). All patients underwent C1 laminectomy in addition to FMD, and 10% also C2 laminectomy. Short term complications occurred in 7 cases (8%). All were wound problems which did not require reoperation. Median follow-up time was 3&#xa0;years (range 1–13).</p> <p>Postoperatively:<UnorderedList Mark="Bullet"> <ItemContent> <p>Headaches improved in 90% (45/50)</p> </ItemContent> <ItemContent> <p>Syrinx size reduced or was stable in 87% (42/48)</p> </ItemContent> <ItemContent> <p>Syrinx size progression was seen in 13% (6/48)</p> </ItemContent> <ItemContent> <p>Four patients (4%) developed a new syrinx following the procedure</p> </ItemContent> <ItemContent> <p>Neurological deficits improved or stabilized in 87% (34/40)</p> </ItemContent> </UnorderedList></p> <p>No surgical site infection, CSF leak, hydrocephalus, or new permanent neurological deficits were observed. The reoperation rate was 10%.</p> Conclusion <p>Our results indicate that extradural FMD with MSDI can be considered a safe and effective treatment of CM I in pediatric patients, even in the presence of syringomyelia. No correlations between age, gender, scoliosis, tonsil herniation level, follow-up length, syrinx size and level, CXA, pB-C2, surgeon, and syrinx changes after surgery were found. Age showed no significant correlation with postoperative headache improvement.</p>

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Extradural foramen magnum decompression with multiple superficial dural incisions for Chiari I malformation: a multicenter series of 91 pediatric patients

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Olga Sergeenko,
  • Jonathan Roth,
  • Jehuda Soleman,
  • Manina Maja Etter,
  • Raphael Guzman,
  • Akiva Korn,
  • Yulia Arestova,
  • Dmitry Savin,
  • Maya Zusman Cohen,
  • Carla Richetta,
  • Shlomi Constantini

摘要

Purpose

To assess surgical outcome of pediatric patients undergoing foramen magnum decompression (FMD) with multiple superficial dural incisions (MSDI) in Chiari I malformation (CM I), with or without syringomyelia.

Methods

A retrospective review of 91 pediatric patients who underwent FMD with MSDI technique between 2010 and 2024 at three tertiary neurosurgical centers.

Results

Median age at surgery was 10 years (range 1–18). 57% were female. Preoperative symptoms included headaches/neck pain (55%), neurological deficits (44%), dysphagia (13%), snoring (18%), and cranial nerve involvement (12%). Syringomyelia was present in 48 patients (53%). All patients underwent C1 laminectomy in addition to FMD, and 10% also C2 laminectomy. Short term complications occurred in 7 cases (8%). All were wound problems which did not require reoperation. Median follow-up time was 3 years (range 1–13).

Postoperatively:

Headaches improved in 90% (45/50)

Syrinx size reduced or was stable in 87% (42/48)

Syrinx size progression was seen in 13% (6/48)

Four patients (4%) developed a new syrinx following the procedure

Neurological deficits improved or stabilized in 87% (34/40)

No surgical site infection, CSF leak, hydrocephalus, or new permanent neurological deficits were observed. The reoperation rate was 10%.

Conclusion

Our results indicate that extradural FMD with MSDI can be considered a safe and effective treatment of CM I in pediatric patients, even in the presence of syringomyelia. No correlations between age, gender, scoliosis, tonsil herniation level, follow-up length, syrinx size and level, CXA, pB-C2, surgeon, and syrinx changes after surgery were found. Age showed no significant correlation with postoperative headache improvement.