Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Symptoms

Eric M Jackson; Sarah Jernigan; Jeffrey S Raskin; Laurie L Ackerman; Libby Kosnik Infinger; Cormac O Maher; Toba Niazi; Jogi V Pattisapu; Rabia Qaiser; Carolyn Quinsey; Brandon G Rocque; Howard Silberstein; Shobhan Vachhrajani; David F Bauer

doi:10.1227/neu.0000000000002634

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Symptoms

Neurosurgery. 2023 Oct 1;93(4):727-730. doi: 10.1227/neu.0000000000002634. Epub 2023 Aug 30.

Authors

Affiliations

¹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA.
² Carolina Neurosurgery & Spine Associates, Charlotte , North Carolina , USA.
³ Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA.
⁴ Department of Neurological Surgery, Indiana University Health, Indianapolis , Indiana , USA.
⁵ Department of Neurosurgery, Medical University of South Carolina (MUSC), Charleston , South Carolina , USA.
⁶ Department of Neurosurgery, Stanford Medicine, Palo Alto , California , USA.
⁷ Department of Neurological Surgery, Nicklaus Children's Hospital, Miami , Florida , USA.
⁸ Pediatric Neurosurgery, University of Central Florida College of Medicine, Orlando , Florida , USA.
⁹ Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis , Indiana , USA.
¹⁰ Department of Neurosurgery, University of North Carolina Chapel Hill, Chapel Hill , North Carolina , USA.
¹¹ Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , Alabama , USA.
¹² Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester , New York , USA.
¹³ Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton , Ohio , USA.
¹⁴ Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA.
¹⁵ Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston , Texas , USA.

PMID: 37646519
DOI: 10.1227/neu.0000000000002634

Abstract

Background: Chiari I malformation (CIM) is characterized by descent of the cerebellar tonsils through the foramen magnum, potentially causing symptoms from compression or obstruction of the flow of cerebrospinal fluid. Diagnosis and treatment of CIM is varied, and guidelines produced through systematic review may be helpful for clinicians.

Objective: To perform a systematic review of the medical literature to answer specific questions on the diagnosis and treatment of CIM.

Methods: PubMed and Embase were queried between 1946 and January 23, 2021, using the search strategies provided in Appendix I of the full guidelines.

Results: The literature search yielded 430 abstracts, of which 79 were selected for full-text review, 44 were then rejected for not meeting the inclusion criteria or for being off-topic, and 35 were included in this systematic review.

Conclusion: Four Grade C recommendations were made based on Class III evidence, and 1 question had insufficient evidence. The full guidelines can be seen online at https://www.cns.org/guidelines/browse-guidelines-detail/2-symptoms .

Publication types

Systematic Review

MeSH terms

Arnold-Chiari Malformation* / diagnosis
Arnold-Chiari Malformation* / surgery
Evidence Gaps
Foramen Magnum
Humans
Neurosurgeons*
Patients