Outcomes in Patients Undergoing Surgical Intervention for Chiari Type I Malformation with Syringomyelia

 

Grant Recipient: Bermans J. Iskandar, MD, University of Wisconsin at Madison, Tim M. George, MD, University of Texas at Austin Sponsored by the American Society of Pediatric Neurosurgeons

Grant Amount: $210,000 ($105,000 per year)

Purpose of the study: This is a pilot study that aims to determine the feasibility of large, federally-funded, multicenter trials in Chiari I and syringomyelia. The hope is to give this type of rigorous research in the Chiari/syringomyelia field a “kick-start” nationally and internationally, so that we can ultimately minimize controversy and start answering fundamental questions.

The experimental methodology consists of prospectively collecting clinical and radiographic data, thus allowing the establishment of study protocols to evaluate surgical approaches and outcomes of patients with Chiari I and syringomyelia.  By recruiting children with documented Chiari I and syringomyelia at several institutions that differ in their surgical approaches, the investigators will attempt to compare the results of the three main surgical techniques: 1) Bone decompression;2) Bone decompression with duraplasty; and 3) Bone decompression with duraplasty and tonsillar shrinkage.

For the purpose of objectivity, the main endpoint will be resolution of the syrinx.  However, the study will also collect data on the clinical and other radiographic characteristics (e.g., extent of tonsillar descent, cine flow, etc.) of patients who ultimately undergo surgical intervention. This information will be used to determine whether any of these characteristics predict favorable surgical outcome.

This long-overdue prospective multicenter trial, which is a direct result of an ASAP member survey, would be the first of its kind for these disorders.

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