343 Influence of Duraplasty on Clinical, Radiological, and Surgical Factors Associated with Syrinx Location in Children Treated for Chiari Malformation Type I and Syringomyelia: A Park-Reeves Syringomyelia Research Consortium Study

Abstract

INTRODUCTION: Analyses of factors associated with syrinx location in Chiari malformation type I (CM-I) and syringomyelia (SM) are limited by the low individual incidences of syringes in certain spinal cord segments but could have important clinical implications on surgical planning, interpretation of postoperative imaging, and outcomes. METHODS: The Park-Reeves Syringomyelia Research Consortium database of pediatric patients with CM-I with SM was queried for patients who underwent first-time operation for posterior fossa decompression with (PFDD) or without (PFD) duraplasty. Clinical, radiological, and surgical data were compared among patients with cervical, thoracic, cervicothoracic, and holocord syringes. RESULTS: 390 patients (90 cervical, 41 thoracic, 149 cervicothoracic, and 110 holocord) were analyzed. PFDD enhanced the magnitude of change on postoperative imaging in patients with cervical syringes. Patients with cervical or cervicothoracic syringes who underwent PFDD were less likely to develop postsurgical headaches, nausea and vomiting, or infections. However, PFDD was associated with more complications less than 6 months after surgery in patients with thoracic syringes and more complications overall in patients with cervicothoracic and holocord syringes. CONCLUSIONS: In the largest multi-institutional analysis of the effects of syrinx location in CM-I with SM, patients with cervicothoracic and holocord syringes experienced the greatest magnitude of change on postoperative imaging parameters while those with thoracic syringes experienced the fewest and smallest magnitude of postoperative radiological changes. PFDD-associated enhancement of postoperative radiological changes in cervical, thoracic, and holocord syringes did not necessarily translate into improvements in clinical symptoms or complication rates following surgery. PFDD is associated with greater clinical benefit for patients with cervical or cervicothoracic syringes but is less appropriate for patients with thoracic syringes based on outcomes and complication profiles.