Images in neuroscience: central canal kinking in Chiari type I with syringomyelia.

The cerebral aqueduct (CA), or aqueduct of Sylvius, is the narrowest portion of the ventricular system, connecting the third and fourth ventricles and providing an essential conduit for cerebrospinal fluid (CSF) circulation. Despite its small caliber, the CA transmits over 500 ml of CSF daily, and its vulnerability to obstruction makes it central to the pathophysiology of hydrocephalus. This review synthesizes current knowledge of the CA across developmental, anatomical, and clinical dimensions. We examine its embryological formation and the contribution of structures such as the subcommissural organ and Reissner's fiber, highlighting comparative features across species, and evaluate the dynamic physiology of CSF flow in relation to age and disease states. Advances in imaging modalities, including high-resolution magnetic resonance imaging and fetal ultrasound, are summarized in the contexts of both research and clinical practice. Pathological considerations are addressed, ranging from congenital anomalies (e.g., aqueductal webs, Chiari malformations, cavernomas, and forking) to acquired lesions (e.g., gliosis, neoplasia, and trauma-induced stenosis). The genetic underpinnings of aqueductal stenosis are reviewed, emphasizing L1CAM mutations and broader molecular pathways implicated in congenital hydrocephalus. Surgical strategies, including endoscopic third ventriculostomy, aqueductoplasty, and transaqueductal stenting, are critically appraised in terms of efficacy, complication profiles, and long-term outcomes. Overall, this review underscores the CA as a nexus of neurodevelopment, neuropathology, and neurosurgical innovation, and identifies gaps in knowledge that merit future investigation.

Chiari Malformation Type 1 (CM1) is canonically defined by ectopic position of the cerebellar tonsils with additional anatomic variations described inconsistently. Effect on fourth ventricle volume is controversial with prior studies reporting disparate results and methodologically limited to single institution series that hinder generalizability. This limitation was addressed utilizing multiple data sources, longitudinal replication, and reproducible methods using both FreeSurfer and the deep learning-based DL+DiReCT tools for automated volumetrics. First, we analyzed a local retrospective clinical cohort of individuals with CM1 and controls. Using data from the Adolescent Brain Cognitive Development (ABCD) Study, we analyzed volumes at baseline then replicated at two longitudinal timepoints. We then utilized an independent deep learning tool to demonstrate reproducibility with ABCD baseline data. Next, we again replicated with a prospective cohort from the Redefining Chiari (RC) study and compared to controls from the Human Connectome Project Young Adult (HCP-YA) study. Finally, we analyzed a heterogenous dataset from the Park-Reeves Syringomyelia Research Consortium (PRSRC) with comparison to ABCD baseline controls. Our aim was to test the hypothesis of a relationship between fourth ventricle size and CM1. Across all datasets, timepoints, and segmentation tools, we consistently found CM1 associated with smaller fourth ventricle volume. Our findings robustly demonstrate that a smaller fourth ventricle volume is an anatomical feature associated with CM1 at the group level. Fourth ventricle volume in CM1 may provide additional insights into pathophysiology but will require further study to fully elucidate its clinical importance.

A One-Finger-Width "Baklava Dough" Dural Thinning Technique in Dura-Preserving Posterior Fossa Decompression for Chiari Type I Malformation.

Women with Chiari malformation (CM), a congenital physical disability associated with significant chronic pain, frequently experience functional difficulties and depression. This study examined whether chronic pain acceptance, defined as the ability to acknowledge unpleasant sensations without attempting to alter or avoid them, mediates the association between functional difficulties and depression symptoms. This study included a baseline and 1-month follow-up assessment of 100 women with CM. At baseline, participants completed the interference subscale of the Brief Pain Inventory, the Instrumental Activities of Daily Living scale, and the Chronic Pain Acceptance Questionnaire; at 1-month follow-up, participants completed the depression subscale of the 21-item version of the Depression, Anxiety, and Stress Scale. Mediation analyses were conducted using maximum likelihood estimation with missing values. Chronic pain acceptance fully mediated the relationship between Instrumental Activities of Daily Living scores and depression symptoms, accounting for 76% of the total effect (b = 0.87, SE = 0.28, p = .002). Chronic pain acceptance partially mediated the relationship between pain interference and depression symptoms, accounting for 29% of the total effect (b = 0.71, SE = 0.30, p = .02). Chronic pain acceptance may be one possible modifiable mechanism linking functional difficulties and pain interference to depression symptoms among women with CM, suggesting that interventions targeting chronic pain acceptance may reduce depression risk in this population. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Arboleda-Tham syndrome (ARTHS) is a rare autosomal dominant neurodevelopmental disorder caused by pathogenic variants in the lysine acetyltransferase 6A (KAT6A) gene, characterized by global developmental delay, severe speech impairment, craniofacial dysmorphism, and congenital heart defects (CHDs). We retrospectively reviewed data from 14 patients with molecularly confirmed KAT6A variants evaluated at the pediatric neurology center of Seoul National University Children's Hospital between 2018 and 2024. Clinical, genetic, neuroimaging, and laboratory data were systematically analyzed to evaluate the phenotypic spectrum associated with ARTHS. Fourteen patients were identified, 79% of whom were male, with ages ranging from 2 to 14 years at the time of their last visit. Thirteen patients (93%) harbored late-truncating variants. Global developmental delay was universal, with marked speech impairment; most patients remained minimally verbal beyond age 5. Craniofacial dysmorphisms were observed in 11 patients (79%) and CHDs in 6 of the 10 assessed (60%). Notably, 3 of 11 patients (27%) exhibited hematologic abnormalities, ranging from transient neonatal neutropenia to severe aplastic anemia requiring hematopoietic stem cell transplantation. Brain imaging revealed type 1 Chiari malformation and white matter hyperintensities in 2 of the 10 assessed (20%), suggesting a broader neuroanatomic involvement. Radioulnar synostosis was observed in 1 patient, suggesting a possible expansion of the skeletal phenotype in ARTHS. Our study broadens the recognized clinical features of ARTHS by reporting diverse neuroimaging findings, skeletal anomalies including radioulnar synostosis, and hematologic manifestations such as transient neonatal neutropenia and severe aplastic anemia. These findings reinforce the need for multidisciplinary surveillance in ARTHS and suggest potential avenues for further investigation into the role of KAT6A in hematopoiesis, neurodevelopment, and skeletal formation.

Basilar invagination (BI) is a congenital or acquired anomaly of the craniovertebral junction, often accompanied by atlantoaxial dislocation (AAD), Chiari malformation, and syringomyelia, leading to brainstem and cervical spinal cord compression. Surgical failures typically result from inadequate ventral decompression or failure to achieve craniovertebral stability, necessitating technically demanding revision procedures. However, evidence regarding revision strategies and their outcomes remains limited. Therefore, this study aimed to identify the primary procedures associated with failure, characterize revision techniques, and compare outcomes and complications across surgical strategies. We conducted a systematic review analyzing 145 patients from 14 studies who underwent revision surgery for BI. Eligible studies reported both the failed primary surgery and revision outcomes. Data on demographics, prior procedures, revision techniques, radiological and neurological outcomes, and complications were extracted and analyzed descriptively. Posterior fossa decompression (PFD) was the most common failed initial procedure (92/145, 63.4%), followed by occipitocervical fusion (OCF) (35/145, 24.1%), posterior C1-C2 fixation (12/145, 8.3%), and anterior decompression (6/145, 4.1%). The leading cause of revision was structural failure or persistent instability (95/145, 65.5%), particularly after PFD (41.4%) and OCF (16.6%). Revision surgerier focusing stabilization achieved neurological improvement and optimal radiological alignment in 116 patients (80%). The procedures with the highest success rates were seen with anterior decompression (51/145, 35.2%), posterior C1-C2 fixation (37/145, 25.5%), and OCF (28/145, 19.3%). Overall, the complications were low, with 73.8% of patients experiencing no adverse events following revision. Surgical failures in BI are predominantly due to inadequate stabilization following decompression-alone procedures. Revision strategies that restore craniovertebral stability provide the best outcomes, highlighting the need for comprehensive, stability-focused surgical planning.

BackgroundIn children with Chiari type I malformation and syringomyelia, neurosurgical posterior fossa decompression (PFD) provides clinical improvement, but whether duraplasty (incising the dura and placing a dural graft) improves outcomes is unclear.MethodsWe conducted a multicenter, cluster-randomized, controlled trial of PFD with duraplasty (PFD-D) as compared with PFD alone. Persons 21 years of age or younger with cerebellar tonsillar ectopia of at least 5 mm and a maximum syrinx diameter of 3.0 to 9.9 mm were enrolled at 38 centers. Centers were cluster-randomized: all the participants within each center underwent the same intervention. The primary outcome was surgical complications within 6 months. Secondary outcomes were clinical improvement, syrinx reduction, and repeat decompression at 10 to 24 months and the change in overall health-related quality of life at 6 to 24 months.ResultsA total of 162 participants were included in the trial, of whom 78 were assigned to undergo PFD-D and 84 to undergo PFD alone. The percentage of participants with complications within 6 months was 14% with PFD-D and 6% with PFD (adjusted odds ratio, 2.59; 95% confidence interval [CI], 0.86 to 7.84; P=0.11). At 24 months, the percentage of participants with clinical improvement was 58% with PFD-D and 46% with PFD; the mean (±SD) syrinx reduction was 3.08±2.33 mm and 1.22±1.79 mm, respectively; and the percentage of participants with repeat decompression was 3% and 14%. Changes in health-related quality of life were similar in the two groups.ConclusionsThe percentage of participants with surgical complications did not differ significantly between those who underwent PFD-D and and those who underwent PFD alone. Larger trials are needed to determine the relative benefits and risks of these two procedures. (Funded by the Patient-Centered Outcomes Research Institute and others; ClinicalTrials.gov number, NCT02669836.)

Objective: Chiari Type I Malformation (CM1) is a structural abnormality of the hindbrain that can cause a range of neurological symptoms and often requires radiological confirmation using magnetic resonance imaging (MRI). The aim of this study was to develop and evaluate a deep feature-based machine learning framework for the automated detection of CM1 from sagittal MRI images. Materials and Methods: The cohort comprised 550 adults: 250 patients with CM1 (168 women, 82 men; age range, 18–65 years) and 300 healthy control participants (210 women, 90 men; age range, 18–65 years). A total of 764 T2-weighted sagittal MR images (384 CM1, 380 healthy) acquired from two different 1.5T MRI scanners (Siemens Magnetom Altea and Symphony) between 2020 and 2024 were retrospectively analyzed. Deep features were extracted using ResNet-50 and MobileNetV2 architectures and subsequently classified using Support Vector Machines (SVM), Logistic Regression (LR), Random Forest (RF), XGBoost, and voting-based ensemble models. Model performance was assessed through patient-level 5-fold cross-validation using accuracy, sensitivity, specificity, F1-score, PPV, NPV, and AUC metrics. Code and trained models are available from the corresponding author upon reasonable request; imaging data are not publicly available due to patient privacy and institutional restrictions. Results: Across patient-level five-fold cross-validation, models built on ResNet-50 deep features demonstrated extremely high and stable diagnostic performance. The final soft-voting ensemble classifier based on ResNet-50 achieved perfect mean performance, with accuracy, balanced accuracy, sensitivity, specificity, F1-score, and AUC all equal to 1.000 ± 0.000 across folds. Other ResNet-based classifiers also achieved near-perfect results. MobileNetV2-based models also demonstrated strong performance but showed slightly lower stability compared with ResNet-based models, with mean accuracies ranging from 0.984 to 0.993 and mean AUC values between 0.99947 and 0.99984 across classifiers. Conclusions: The proposed deep feature-based machine learning framework demonstrated excellent performance for the automated detection of Chiari Type I Malformation from sagittal MRI images. In particular, the ResNet-50–based soft-voting ensemble model achieved perfect classification performance in cross-validation testing, suggesting that deep feature representations combined with machine learning classifiers may serve as a promising computer-aided diagnostic tool for supporting radiological evaluation of CM1.

Long-term intracranial and ophthalmologic sequelae are incompletely characterized for single suture craniosynostosis at a population level. Prior studies are limited by small cohorts and short follow-up. A retrospective cohort study was performed using the Pediatric Health Information System (PHIS) from 2015 to 2024. Children with single-suture craniosynostosis undergoing surgical correction were included. Patients with syndromic and genetic comorbidities were excluded. Prevalence of intracranial diagnoses was compared by suture type. Multivariate logistic regression assessed the association between surgical timing and outcomes, adjusting for gender, race/ethnicity, and suture type. A total of 1602 children met the inclusion criteria (mean follow-up 5.3±3.6y). Sagittal synostosis was associated with elevated intracranial pressure (ICP) (6.3%), unicoronal synostosis with ophthalmologic complications (23.6%), and lambdoid synostosis with Chiari I malformation (17.9%) (all P<0.05). Compared with surgery before 6 months, surgery at 1 to 2 years was associated with increased odds of elevated intracranial pressure (OR: 2.19, 95% CI: 1.09-4.43, P=0.029) and hydrocephalus (OR: 3.79, 95% CI: 1.41-10.23, P=0.008). Surgery at 2 to 4 years was associated with increased odds of elevated intracranial pressure (OR: 4.98, 95% CI: 2.57-9.66), Chiari malformation (OR: 5.50, 95% CI: 2.40-12.62) (all P≤0.002), and hydrocephalus (OR: 3.17, 95% CI: 1.07-9.42, P=0.037). Surgical age was not associated with ophthalmologic outcomes among patients with unicoronal synostosis. These findings characterize the prevalence of long-term intracranial morbidity for single suture craniosynostosis on a national scale and emphasize the importance of suture-specific long-term postoperative surveillance.

Chiari malformation type 1 (CM-1) is traditionally defined by tonsillar herniation, yet clinical symptoms often correlate poorly with simple linear measurements. Emerging research suggests that the geometry of the fourth ventricle may reflect deeper developmental anomalies. This study aimed to evaluate the association between fourth ventricular roof angle (FVRA) geometry and brainstem dysfunction and to determine its utility as a prognostic marker for symptomatic presentation and surgical outcomes. Following PRISMA guidelines and PROSPERO registration (CRD420261301268), a systematic search of Medline, Scopus, Web of Science, and Embase was conducted through January 2026. Studies reporting FVRA and BSD outcomes (apnea, dysphagia, cranial nerve deficits) were included. Statistical analysis was performed using the meta package in R (Version 4.1.0). A random-effects model was employed to calculate pooled Odds Ratios (OR) and 95% confidence intervals (CI), with heterogeneity assessed via I2 and chi-squared tests. Quality was appraised using the NIH Quality Assessment Tool. Three high-quality observational cohorts (N = 556 patients) were included. Quantitative synthesis revealed that an FVRA > 65° is a significant radiographic correlate of BSD, demonstrating a nearly threefold increase in symptomatic risk (pooled OR 2.79; 95% CI 1.44-5.41). In the obtuse angle group (> 65°), 29.9% of patients exhibited BSD, compared to 12.5% in the group with angles ≤ 65°. Significant heterogeneity was observed (I2 = 67.7%). Despite the strong univariate association, multivariate data from the included studies indicated that FVRA utility is confounded by tonsillar position and does not reliably predict postoperative surgical outcomes. Abnormal fourth ventricular geometry is a statistically significant indicator of the "symptomatic Chiari phenotype," supporting a developmental model of CM-I involving intrinsic neural tube failures. While the FVRA offers high inter-rater reliability, its current clinical role is as a supplemental screening tool within comprehensive assessment algorithms rather than a standalone surgical trigger.

Syringomyelia is a progressive neurological disorder characterized by intramedullary fluid-filled cavities. Shunt placement remains a key treatment option when decompression fails, yet comparative outcomes across shunt types remain poorly defined. The aim of this study was to compare revision rates, time to failure, and neurological outcomes among patients treated with syringopleural, syringosubarachnoid, and syringoperitoneal shunts. A retrospective review was conducted using a prospectively maintained database of the senior surgeon from 1997 to 2025 to identify patients who underwent syrinx shunt placement. Demographic data, shunt type, revision rates, time to revision, and neurological outcomes at early and late follow-up time points were analyzed. Revision was defined as a return to the operating room for shunt-related complications. Thirty-one patients (19 male, mean age 47.2 years) underwent 48 surgeries for placement of syringopleural (n = 20, 41.7%), syringosubarachnoid (n = 21, 43.8%), and syringoperitoneal (n = 7, 14.6%) shunts. Common etiologies included traumatic injury and Chiari malformation. Ten patients (32.2%) required at least one revision surgery, while 21 patients (67.7%) did not require revision. The mean hospital length of stay was significantly longer for syringosubarachnoid (10.1 days) and syringoperitoneal (10.0 days) compared with syringopleural (5.4 days) surgeries (p = 0.036). Revision rates were highest for syringopleural shunts (55.0%), followed by syringoperitoneal (28.6%) and syringosubarachnoid (19.0%) (p = 0.003). Early motor and/or sensory function improvement was observed in 55.0% of syringopleural cases, 33.3% of syringosubarachnoid cases, and 14.3% of syringoperitoneal cases (p = 0.117). Sustained long-term improvement was rare across all groups (p = 0.551). The mean time to revision surgery was 1093 days for syringopleural, 515 days for syringosubarachnoid, and 89 days for syringoperitoneal shunts (p = 0.144). Syrinx shunting provided modest early neurological benefit, but long-term durability remained limited. Syringopleural shunts demonstrated greater early clinical improvement but carried greater revision risk. Syringosubarachnoid shunts had lower mechanical failure rates but limited clinical efficacy. Optimizing patient selection and vigilant postoperative monitoring are crucial. Further research is needed to refine surgical strategies and improve durable outcomes.

Isolated bilateral lambdoid and sagittal synostosis (iBLSS) has been of particular interest as a special entity and is commonly associated with hydrocephalus and Chiari malformation type I (CM-I). The authors present the case of a 5-month-old female diagnosed with iBLSS, complicated by hydrocephalus and CM-I, and review the available literature. At 5.5 months of age, the child underwent endoscopic release of the fused sagittal and bilateral lambdoid sutures. Follow-up at 5 years of age showed significant craniofacial improvement and resolution of the hydrocephalus and CM-I, which has not been previously reported in the literature. Literature review included 95 cases, with the most common association being CM-I, followed by hydrocephalus and increased intracranial pressure. The majority of patients underwent cranial vault release with or without foramen magnum decompression. Endoscopic release is an effective approach for managing iBLSS and led to the resolution of hydrocephalus and CM-I in the present case. https://thejns.org/doi/10.3171/CASE251019.

Background: Chiari malformation (type 1) is a rare condition in which the cerebellar tonsils descend through the foramen magnum into the spinal canal. This in turn leads to compression of the spinal cord at foramen magnum interfering with the flow of cerebrospinal fluid leading to craniospinal dissociation and as a result hydrocephalus and syringomyelia. Sometimes it occurs secondary to space occupying lesions in intracranial compartments.

While neurosurgical posterior fossa decompression with duraplasty (PFDD) may provide clinical and radiological improvement for Chiari malformation-I (CM-I)-syringomyelia, the comparative efficacy and safety of PFDD without vs with intradural tonsillar manipulation (posterior fossa decompression with tonsil resection) has remained controversial for over 5 decades. We conducted a retrospective cohort study of 1231 CM-I-syringomyelia patients treated at our institution from 2003 to 2024, comparing 2 techniques: standard PFDD and foramen magnum and foramen of magendie dredging (FMMD, a modified posterior fossa decompression with tonsil resection procedure). Propensity score matching was used to balance baseline characteristics between the 2 groups. The primary outcomes were syrinx regression >50%, while secondary outcomes encompassed symptom-related parameters, syrinx regression, complication-related parameters, and reoperation rate. A total of 1231 patients with CM-I were included, of whom 310 (25.2%) were in the PFDD group, and 921 (74.8%) were in the FMMD group. Per treatment analysis demonstrated no increase in odds of complications for FMMD ( P > .05). PFDD was noninferior to FMMD in clinical improvement and syrinx regression ( P = .147, P = .169, respectively). Syrinx regression (>50% reduction) was superior following FMMD (78% vs 60%, P < .001). PFDD had a higher rate of revision surgery than FMMD (15.5% vs 4.1%, log-rank P < .001). At our center, FMMD demonstrated greater effectiveness in managing syringomyelia, with higher rates of syrinx regression (>50% reduction), a lower rate of revision surgery, and no increase in complications compared with PFDD. Nonetheless, PFDD was similar to FMMD regarding clinical improvement and syrinx regression.

Scoliosis associated with Chiari I malformation after posterior fossa decompression: a systematic review and meta-analysis of 380 pediatric patients.

To the Editor: In our recent publication, we identified 3 presenting phenotypes of Chiari type 1 malformation and syringomyelia using a clustering approach that integrated clinically informed and data-driven feature selection.1 As part of our methodology, we applied the Laplacian score, an unsupervised ranking method, to select informative features for clustering.2 In our original analysis, we selected features based on literature that interpreted higher Laplacian scores as indicating more informative features.3-5 In subsequent work, we have encountered alternative interpretations in the literature supporting lower scores as more desirable.6,7 On careful investigation, we believe the latter offers a more appropriate interpretation. The Laplacian score quantifies how much a feature varies across locally neighboring data points. Features with lower scores demonstrate greater locality-preserving power, as they vary less within local neighborhoods, thus better maintaining the intrinsic structure of the data set. Given the presence of conflicting interpretations in the literature, we believe it is important to raise awareness of this methodological ambiguity and to provide results with feature selection based on lower Laplacian scores. As such, we have repeated our analysis using the revised criterion and summarized the updated findings in comparison with the original results. The updated results are presented in Figure, with details provided in Supplemental Digital Content eTable 1 and eFigures 1 and 2 (https://links.lww.com/NEU/F285). Although this adjustment changed the ranking of data-driven features, many of the newly selected features overlapped with those from the original analysis, as shown in the Supplemental Digital Content Methods (https://links.lww.com/NEU/F285). This consistency is attributable to the integration of clinical guidance, which involved clinical surveys and grouping features into clinically meaningful categories.FIGURE.: Top panel shows results from the original analysis, and bottom panel shows updated results using the revised Laplacian score criterion.As shown in Figure, the clustering patterns and clinical interpretations continue to support the primary conclusions of the study, with the data-driven methodology supporting the inclusion of specific characteristics identified as important by clinical experts, including syrinx diameter, presence of occipital/suboccipital headaches, and degree of tonsillar descent. The revised methodology also supports the inclusion of other clinical or radiologic data including reflexes, sensory changes, and pBC2 distance. The cluster characteristics and overall phenotypes remain largely the same, particularly with respect to defining factors such as diagnosis age, syrinx size, bulbar symptoms, presence of hydrocephalus, spinal column abnormalities, and degree of tonsillar descent. Interestingly, the distribution pattern of several other characteristics such as physical exam findings and presence other medical issues, many of which had lower magnitude differences in the initial analysis, has changed slightly within each group. Although this may suggest that these factors are less important for clustering as they are not preserved between analyses, the exact implications remain unclear, and further investigation into the complex relationship of these factors with Chiari type 1 phenotypes is certainly warranted. We appreciate the opportunity to share this updated analysis.

Postoperative pain following Chiari malformation decompression is frequently severe and may contribute to substantial postoperative healthcare utilization. Although multimodal analgesic strategies are increasingly utilized across surgical specialties, postoperative pain management practices following Chiari decompression remain variable and poorly characterized. This exploratory retrospective study aimed to characterize postoperative analgesic practices and associated healthcare utilization outcomes following Chiari decompression. A retrospective cohort study was conducted of adult patients undergoing Chiari decompression across four institutions between 2016 and 2023. Postoperative analgesic regimens, including opioid and non-opioid medications, were recorded. Outcomes included postoperative pain scores, length of stay (LOS), postoperative imaging utilization, emergency department (ED) visits within 60 days of surgery, and readmissions. Twenty-seven patients met inclusion criteria. Postoperative analgesic regimens were heterogeneous, with all patients receiving opioid medications and variable use of non-opioid adjuncts. Eleven patients (40.7%) presented to the ED during the postoperative period, most commonly for headache or pressure-related symptoms. These presentations frequently required additional pharmacologic management and diagnostic imaging, including computed tomography in 63.6% of cases and magnetic resonance imaging in 18.2%. Two patients were subsequently found to have cerebrospinal fluid leaks requiring operative intervention. Exploratory analysis demonstrated lower postoperative day 0 pain scores among patients receiving non-steroidal anti-inflammatory drugs (NSAIDs). Postoperative pain and healthcare utilization following Chiari decompression remain important clinical challenges. In this exploratory retrospective cohort, postoperative analgesic practices were variable, and a substantial proportion of patients required postoperative ED evaluation and additional imaging. These findings highlight the persistent postoperative symptom burden experienced by this patient population and may help inform future prospective evaluation of perioperative pain management pathways and postoperative care strategies following Chiari decompression.

Endoscopic suturectomy represents an early intervention for craniosynostosis. For unilateral lambdoid craniosynostosis, this study reviews the existing literatures and summarizes a single-center experience with endoscopic management of lambdoid-related plagiocephaly. Our findings indicate that endoscopic surgery combined with orthotic helmet therapy can effectively improve cranial deformities, torticollis, and other associated abnormalities. However, the correction of compensatory deformities and the long-term outcomes related to Chiari malformation and other neurocognitive functions still require further investigation.

Chiari malformation Type I (CMI) is a chronic pain syndrome associated with an increase in disability. However, little is known about the relationship between pain and disability among CMI patients. Using a web-based study of 372 adults diagnosed with CMI, we examined pain catastrophizing along with self-reported pain, head and neck disability, loneliness, depression, anxiety, and stress. Our primary analytic method was statistical mediation. Pain catastrophizing was positively correlated with self-reported pain, depression, anxiety, and disability. Finally, pain catastrophizing (rumination and helplessness subscales) mediated the relationship between Pain scores and Disability scores in this sample of CMI patients. Our findings are that pain catastrophizing mediates the effect of pain on disability-but depression does not. The importance of pain catastrophizing in explaining the relationship between pain and disability may provide new insight into more effect treatments for chronic pain and disability in CMI.