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056. Factors predicting surgical management in children with Chiari I malformation: is it radiological, clinical or both?

Authors: Maria Fernanda Dien Esquivel

Introduction:
The aim of this study was to describe radiological and clinical parameters in Chiari I malformation (CM1) patients that predict for surgical intervention.Methods: This is a retrospective study of patients between 0-18 years with CM1 identified between January 1, 2007 to February 12, 2020 seen at CHEO. Participants were included only if they had a baseline MRI of the head and SPINE prior to surgical intervention if offered. 40 age matched controls were identified for comparison. Multiple imaging parameters and clinical symptoms were recorded.
Results:
A total cohort of 122 CM1 patients were included in this study. Of the 122 patients, 28 (23%) had syrinx, 27 (22%) had surgery and 95 (78%) had no surgery. We identified that the length of the midbrain, the position of the obex, kinking of the medulla, the presence of syrinx, the whole tonsillar length and the length of the herniated tonsils were found to be predictors for need for intervention. Among the clinical features, the presence of neck pain, the presence of occipital headaches, apnea, swallowing abnormalities and sensory dysfunction were predictors for surgery when compared to CM1 patients without surgery and controls.
Conclusion:
While further investigation is needed, these results suggest that length of the midbrain, obex position, the presence of syrinx, the whole tonsillar length, the length of the herniated tonsils and kinking of the medulla should be included as radiological parameters when evaluating CM1 patients and may be useful to guide clinical management. The presence of symptoms, neck pain, occipital headaches, apnea, swallowing abnormalities and sensory dysfunction should be included as clinical parameters. These results warrant assessment and replication in larger prospective studies. We believe that our study will contribute to further objectify the criteria that should be taken in consideration when considering further clinical management in pediatric patients with CM1.