1275. Improvement in Cerebral Spinal Fluid Flow, as seen post Decompression, is associated with improved symptoms in Chiari I Malformation patients: a multi-institutional study

Authors: Luke Alan Mugge; Camila Dassi, MD; Andrew Caras; Nicholas Henkel; Jason Schroeder; Daniel Prevedello; Tarek Mansour (Perrysburg, OH)

Introduction: Arnold Chiari I malformation is a common pediatric neurological condition for which occipital craniectomy is the standard treatment. We propose cerebral spinal fluid (CSF) flow as a potential effective indicator of surgical efficacy and post-operative symptom alleviation after decompression. Methods: We performed a retrospective analysis of patients who underwent a decompression occipital craniotomy from symptomatic Chiari malformations. This was a multiple institutional approach. Patient charts were reviewed to examine Flow studies and pre and post-operative symptom profiles. Results: 51 patients were identified who met inclusion criteria among four different surgeons at two institutions between 2010 and 2017. The average age was 36.36 years with 49 females and 2 males. Post decompression, 43 patients demonstrated improved CSF flow. 40 patients reported to be improved symptomatically, 10 were the same status, and 1 was worse. Patients were divided into two groups. Group A was composed of patients with improved CSF flow. Group B was patients who did not have improved flow. Group A, with improved CSF flow, demonstrated superior clinical outcomes, which were statistically significant, with 36 patients (83.72%) demonstrating improvement versus only 4 patients (50%) for Group B (p<0.05; 0.033229). Specifically, Group A demonstrated improvement of symptoms compared to group B including headache (52.63% vs. 37.5% improvement), Neck Pain (66.66% vs. 33.33%), Dizziness (80% vs 50%), vision (85% vs 80%), and weakness (80% vs. 66.66%). Group B contained the only patient noted to do worse on clinical follow-up and to have worse headaches post-operatively. Conclusion: We demonstrate a positive correlation between decompression and improved CSF flow. Our study reveals that improved CSF flow, seen post-decompression by MRI flow studies, represents an effective prognostic indicator of ideal patient outcomes and improved symptomatology.