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Article Dans Une Revue Journal of Neurosurgery. Pediatrics Année : 2022

Chiari malformation type I surgery in children: French multicenter 10-year cohort

Edouard Mazerand
  • Fonction : Auteur
Sandro Benichi
  • Fonction : Auteur
Maxime Taverne
  • Fonction : Auteur
Giovanna Paternoster
  • Fonction : Auteur
Alice Rolland
  • Fonction : Auteur
Pierre Antherieu
  • Fonction : Auteur
Julien Todeschi
  • Fonction : Auteur
Lawrence Kamdem Noumoye
  • Fonction : Auteur
Vianney Gilard
  • Fonction : Auteur
Maxime Bretonnier
  • Fonction : Auteur
Luc Le Fournier
  • Fonction : Auteur
Vincent Jecko
  • Fonction : Auteur
Edouard Gimbert
  • Fonction : Auteur
François Proust
  • Fonction : Auteur
Sergio Boetto
  • Fonction : Auteur
Thomas Roujeau
  • Fonction : Auteur
Syril James
  • Fonction : Auteur
Roman Khonsari
  • Fonction : Auteur
Laurent Riffaud
  • Fonction : Auteur
Matthieu Delion
  • Fonction : Auteur
Michel Zerah
  • Fonction : Auteur
Didier Scavarda
  • Fonction : Auteur

Résumé

OBJECTIVE Chiari malformation type I (CM-I) is frequent in children and remains a surgical challenge. Several techniques have been described for posterior fossa decompression. No decision algorithm has been validated, and strategies are highly variable between institutions. The goal of this study was to define therapeutic guidelines that take into consideration patient specificities. METHODS The authors retrospectively collected data from patients who were < 18 years of age, were diagnosed with CM-I, and were treated surgically between 2008 and 2018 in 8 French pediatric neurosurgical centers. Data on clinical features, morphological parameters, and surgical techniques were collected. Clinical outcomes at 3 and 12 months after surgery were assessed by the Chicago Chiari Outcome Scale. The authors used a hierarchical clustering method to define clusters of patients by considering their anatomical similarities, and then compared outcomes between surgical strategies in each of these clusters. RESULTS Data from 255 patients were collected. The mean age at surgery was 9.6 ± 5.0 years, syringomyelia was reported in 60.2% of patients, the dura mater was opened in 65.0% of patients, and 17.3% of patients underwent a redo surgery for additional treatment. The mean Chicago Chiari Outcome Scale score was 14.4 ± 1.5 at 3 months (n = 211) and 14.6 ± 1.9 at 12 months (n = 157). The hierarchical clustering method identified three subgroups with potentially distinct mechanisms underlying tonsillar herniation: bony compression, basilar invagination, and foramen magnum obstruction. Each cluster matched with specific outcomes. CONCLUSIONS This French multicenter retrospective cohort study enabled the identification of three subgroups among pediatric patients who underwent surgery for CM-I, each of which was associated with specific outcomes. This morphological classification of patients might help in understanding the underlying mechanisms and providing personalized treatment.
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Dates et versions

hal-04227719 , version 1 (04-10-2023)

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Edouard Mazerand, Sandro Benichi, Maxime Taverne, Giovanna Paternoster, Alice Rolland, et al.. Chiari malformation type I surgery in children: French multicenter 10-year cohort. Journal of Neurosurgery. Pediatrics, 2022, 30 (2), pp.210-216. ⟨10.3171/2022.4.PEDS21410⟩. ⟨hal-04227719⟩
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