Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry

Irene Kim, Betsy Hopson, Inmaculada Aban, Elias Rizk, Mark Dias, Robin Bowman, Laurie L. Ackerman, Michael D. Partington, Heidi Castillo, Jonathan Castillo, Paula R. Peterson, Jeffrey P. Blount, Brandon G. Rocque

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Abstract

Objective: The purpose of this study was to determine the rate of decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry (NSBPR). In addition, the authors explored the variation in rates of Chiari II decompression across NSBPR institutions, examined the relationship between Chiari II decompression and functional lesion level of the myelomeningocele, age, and need for tracheostomy, and they evaluated for temporal trends in rates of Chiari II decompression. Methods: The authors queried the NSBPR to identify all individuals with myelomeningocele between 2009 and 2015. Among these patients, they identified individuals who had undergone at least 1 Chiari II decompression as well as those who had undergone tracheostomy. For each participating NSBPR institution, the authors calculated the proportion of patients enrolled at that site who underwent Chiari II decompression. Logistic regression was performed to analyze the relationship between Chiari II decompression, functional lesion level, age at decompression, and history of tracheostomy. Results: Of 4448 individuals with myelomeningocele identified from 26 institutions, 407 (9.15%) had undergone at least 1 Chiari II decompression. Fifty-one patients had undergone tracheostomy. Logistic regression demonstrated a statistically significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, with a more rostral lesion level associated with a higher likelihood of posterior fossa decompression. Similarly, children born before 2005 and those with history of tracheostomy had a significantly higher likelihood of Chiari II decompression. There was no association between functional lesion level and need for tracheostomy. However, among those children who underwent Chiari II decompression, the likelihood of also undergoing tracheostomy increased significantly with younger age at decompression. Conclusions: The rate of Chiari II decompression in patients with myelomeningocele in the NSBPR is consistent with that in previously published literature. There is a significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, which has not previously been reported. Younger children who undergo Chiari II decompression are more likely to have undergone tracheostomy. There appears to be a shift away from Chiari II decompression, as children born before 2005 were more likely to undergo Chiari II decompression than those born in 2005 or later.

Original languageEnglish (US)
Pages (from-to)652-658
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume22
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Arnold-Chiari Malformation
Meningomyelocele
Spinal Dysraphism
Decompression
Registries
Tracheostomy
Logistic Models

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Kim, Irene ; Hopson, Betsy ; Aban, Inmaculada ; Rizk, Elias ; Dias, Mark ; Bowman, Robin ; Ackerman, Laurie L. ; Partington, Michael D. ; Castillo, Heidi ; Castillo, Jonathan ; Peterson, Paula R. ; Blount, Jeffrey P. ; Rocque, Brandon G. / Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry. In: Journal of Neurosurgery: Pediatrics. 2018 ; Vol. 22, No. 6. pp. 652-658.
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title = "Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry",
abstract = "Objective: The purpose of this study was to determine the rate of decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry (NSBPR). In addition, the authors explored the variation in rates of Chiari II decompression across NSBPR institutions, examined the relationship between Chiari II decompression and functional lesion level of the myelomeningocele, age, and need for tracheostomy, and they evaluated for temporal trends in rates of Chiari II decompression. Methods: The authors queried the NSBPR to identify all individuals with myelomeningocele between 2009 and 2015. Among these patients, they identified individuals who had undergone at least 1 Chiari II decompression as well as those who had undergone tracheostomy. For each participating NSBPR institution, the authors calculated the proportion of patients enrolled at that site who underwent Chiari II decompression. Logistic regression was performed to analyze the relationship between Chiari II decompression, functional lesion level, age at decompression, and history of tracheostomy. Results: Of 4448 individuals with myelomeningocele identified from 26 institutions, 407 (9.15{\%}) had undergone at least 1 Chiari II decompression. Fifty-one patients had undergone tracheostomy. Logistic regression demonstrated a statistically significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, with a more rostral lesion level associated with a higher likelihood of posterior fossa decompression. Similarly, children born before 2005 and those with history of tracheostomy had a significantly higher likelihood of Chiari II decompression. There was no association between functional lesion level and need for tracheostomy. However, among those children who underwent Chiari II decompression, the likelihood of also undergoing tracheostomy increased significantly with younger age at decompression. Conclusions: The rate of Chiari II decompression in patients with myelomeningocele in the NSBPR is consistent with that in previously published literature. There is a significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, which has not previously been reported. Younger children who undergo Chiari II decompression are more likely to have undergone tracheostomy. There appears to be a shift away from Chiari II decompression, as children born before 2005 were more likely to undergo Chiari II decompression than those born in 2005 or later.",
author = "Irene Kim and Betsy Hopson and Inmaculada Aban and Elias Rizk and Mark Dias and Robin Bowman and Ackerman, {Laurie L.} and Partington, {Michael D.} and Heidi Castillo and Jonathan Castillo and Peterson, {Paula R.} and Blount, {Jeffrey P.} and Rocque, {Brandon G.}",
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Kim, I, Hopson, B, Aban, I, Rizk, E, Dias, M, Bowman, R, Ackerman, LL, Partington, MD, Castillo, H, Castillo, J, Peterson, PR, Blount, JP & Rocque, BG 2018, 'Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry', Journal of Neurosurgery: Pediatrics, vol. 22, no. 6, pp. 652-658. https://doi.org/10.3171/2018.5.PEDS18160

Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry. / Kim, Irene; Hopson, Betsy; Aban, Inmaculada; Rizk, Elias; Dias, Mark; Bowman, Robin; Ackerman, Laurie L.; Partington, Michael D.; Castillo, Heidi; Castillo, Jonathan; Peterson, Paula R.; Blount, Jeffrey P.; Rocque, Brandon G.

In: Journal of Neurosurgery: Pediatrics, Vol. 22, No. 6, 01.12.2018, p. 652-658.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry

AU - Kim, Irene

AU - Hopson, Betsy

AU - Aban, Inmaculada

AU - Rizk, Elias

AU - Dias, Mark

AU - Bowman, Robin

AU - Ackerman, Laurie L.

AU - Partington, Michael D.

AU - Castillo, Heidi

AU - Castillo, Jonathan

AU - Peterson, Paula R.

AU - Blount, Jeffrey P.

AU - Rocque, Brandon G.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objective: The purpose of this study was to determine the rate of decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry (NSBPR). In addition, the authors explored the variation in rates of Chiari II decompression across NSBPR institutions, examined the relationship between Chiari II decompression and functional lesion level of the myelomeningocele, age, and need for tracheostomy, and they evaluated for temporal trends in rates of Chiari II decompression. Methods: The authors queried the NSBPR to identify all individuals with myelomeningocele between 2009 and 2015. Among these patients, they identified individuals who had undergone at least 1 Chiari II decompression as well as those who had undergone tracheostomy. For each participating NSBPR institution, the authors calculated the proportion of patients enrolled at that site who underwent Chiari II decompression. Logistic regression was performed to analyze the relationship between Chiari II decompression, functional lesion level, age at decompression, and history of tracheostomy. Results: Of 4448 individuals with myelomeningocele identified from 26 institutions, 407 (9.15%) had undergone at least 1 Chiari II decompression. Fifty-one patients had undergone tracheostomy. Logistic regression demonstrated a statistically significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, with a more rostral lesion level associated with a higher likelihood of posterior fossa decompression. Similarly, children born before 2005 and those with history of tracheostomy had a significantly higher likelihood of Chiari II decompression. There was no association between functional lesion level and need for tracheostomy. However, among those children who underwent Chiari II decompression, the likelihood of also undergoing tracheostomy increased significantly with younger age at decompression. Conclusions: The rate of Chiari II decompression in patients with myelomeningocele in the NSBPR is consistent with that in previously published literature. There is a significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, which has not previously been reported. Younger children who undergo Chiari II decompression are more likely to have undergone tracheostomy. There appears to be a shift away from Chiari II decompression, as children born before 2005 were more likely to undergo Chiari II decompression than those born in 2005 or later.

AB - Objective: The purpose of this study was to determine the rate of decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry (NSBPR). In addition, the authors explored the variation in rates of Chiari II decompression across NSBPR institutions, examined the relationship between Chiari II decompression and functional lesion level of the myelomeningocele, age, and need for tracheostomy, and they evaluated for temporal trends in rates of Chiari II decompression. Methods: The authors queried the NSBPR to identify all individuals with myelomeningocele between 2009 and 2015. Among these patients, they identified individuals who had undergone at least 1 Chiari II decompression as well as those who had undergone tracheostomy. For each participating NSBPR institution, the authors calculated the proportion of patients enrolled at that site who underwent Chiari II decompression. Logistic regression was performed to analyze the relationship between Chiari II decompression, functional lesion level, age at decompression, and history of tracheostomy. Results: Of 4448 individuals with myelomeningocele identified from 26 institutions, 407 (9.15%) had undergone at least 1 Chiari II decompression. Fifty-one patients had undergone tracheostomy. Logistic regression demonstrated a statistically significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, with a more rostral lesion level associated with a higher likelihood of posterior fossa decompression. Similarly, children born before 2005 and those with history of tracheostomy had a significantly higher likelihood of Chiari II decompression. There was no association between functional lesion level and need for tracheostomy. However, among those children who underwent Chiari II decompression, the likelihood of also undergoing tracheostomy increased significantly with younger age at decompression. Conclusions: The rate of Chiari II decompression in patients with myelomeningocele in the NSBPR is consistent with that in previously published literature. There is a significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, which has not previously been reported. Younger children who undergo Chiari II decompression are more likely to have undergone tracheostomy. There appears to be a shift away from Chiari II decompression, as children born before 2005 were more likely to undergo Chiari II decompression than those born in 2005 or later.

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