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

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

doi:10.1227/neu.0000000000002633

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

Neurosurgery. 2023 Oct 1;93(4):723-726. doi: 10.1227/neu.0000000000002633. Epub 2023 Aug 30.

Authors

David F Bauer^{1

2}, Toba Niazi³, Rabia Qaiser⁴, Libby Kosnik Infinger⁵, Shobhan Vachhrajani⁶, Laurie L Ackerman⁷, Eric M Jackson⁸, Sarah Jernigan⁹, Cormac O Maher¹⁰, Jogi V Pattisapu¹¹, Carolyn Quinsey¹², Jeffrey S Raskin¹³, Brandon G Rocque¹⁴, Howard Silberstein¹⁵

Affiliations

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

PMID: 37646512
DOI: 10.1227/neu.0000000000002633

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 567 abstracts, of which 151 were selected for full-text review, 109 were then rejected for not meeting the inclusion criteria or for being off-topic, and 42 were included in this systematic review.

Conclusion: Three Grade C recommendations were made based on Level III evidence. The full guidelines can be seen online at https://www.cns.org/guidelines/browse-guidelines-detail/1-imaging .

Publication types

Systematic Review

MeSH terms

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