Natural history of Chiari type I malformation in children

• DOI: 10.1007/s10072-011-0684-3
• Publication Date: 2011-09-06T17:53:43Z
• Authors: Luca Massimi; Massimo Caldarelli; Paolo Frassanito; Concezio Di Rocco
• Keywords: Male; Adolescent; Infant; Decompression, Surgical; Arnold-Chiari Malformation; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Humans; Female; Longitudinal Studies; Child; Retrospective Studies

The decision on whether or not to operate children with Chiari type I malformation (CIM) is difficult and controversial, because of the lack of information about the natural evolution of such a disease. Herein, we report on the evolution of 16 asymptomatic children with incidentally diagnosed CIM (mean age: 6.7 years; mean follow-up: 5.8 years). No patients required suboccipital decompression. Thirteen children remained asymptomatic, with stable or improved radiological picture (worsening in 2 cases). Three cases showed appearance of symptoms: one did not require any treatment; the remaining two underwent endoscopic third ventriculostomy because of hydrocephalus, which is a possible consequence of CIM. This analysis shows a favorable natural outcome of CIM in children, thus suggesting a conservative management in asymptomatic cases. However, multicentric studies are required to validate this data.