Comparison of clinical and radiological manifestations and surgical outcomes of pediatric Chiari I malformations in different age groups

The aim of this study was to elucidate the differences in clinical and radiological manifestations and treatment outcomes of pediatric Chiari I malformation patients according to age. We retrospectively reviewed the patients who received surgery in our institution for symptomatic Chiari I malformations between January 1991 and December 2012. Fifty-four patients were identified, and their medical records were reviewed for clinical presentation, radiological findings, surgical treatment, and outcomes including complications. We divided the patients into 3 groups: Group I (n = 4) younger than 3 years old; Group II (n = 9) between 3 and 5 years old; and Group III (n = 41) older than 5 years old. Surveyed data were compared among the groups. The mean follow-up period was 82.8 months. All of Group I patients presented with stem compression signs. Ventriculomegaly was common (3/4, 75 %), but no syrinx or scoliosis was observed. In Group II, scoliosis was the most common presentation (5/9, 56 %), and these patients rarely complained any other symptoms. Pain, such as headache (18/41, 44 %), was the predominant presentation in Group III. The incidences of syrinx and scoliosis were similar in Groups II and III. There were no differences in the treatment outcomes among the groups. The spinal curve did not improve in 4 of 5 Group II patients despite their early FMD surgeries. The incidence of complications related to cerebrospinal fluid leakage was higher in the young age group. The clinical and radiological manifestations of pediatric Chiari I malformation appeared to be different according to age.