Browsing by Author "Greenfield, Jeffrey P."

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    Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data From the Park-Reeves Syringomyelia Research Consortium
    (Wolters Kluwer, 2021-01-13) CreveCoeur, Travis S.; Yahanda, Alexander T.; Maher, Cormac O.; Johnson, Gabrielle W.; Ackerman, Laurie L.; Adelson, P. David; Ahmed, Raheel; Albert, Gregory W.; Aldana, Phillipp R.; Alden, Tord D.; Anderson, Richard C.E.; Baird, Lissa; Bauer, David F.; Bierbrauer, Karin S.; Brockmeyer, Douglas L.; Chern, Joshua J.; Couture, Daniel E.; Daniels, David J.; Dauser, Robert C.; Durham, Susan R.; Ellenbogen, Richard G.; Eskandari, Ramin; Fuchs, Herbert E.; George, Timothy M.; Grant, Gerald A.; Graupman, Patrick C.; Greene, Stephanie; Greenfield, Jeffrey P.; Gross, Naina L.; Guillaume, Daniel J.; Haller, Gabe; Hankinson, Todd C.; Heuer, Gregory G.; Iantosca, Mark; Iskandar, Bermans J.; Jackson, Eric M.; Jea, Andrew H.; Johnston, James M.; Keating, Robert F.; Kelly, Michael P.; Khan, Nickalus; Krieger, Mark D.; Leonard, Jeffrey R.; Mangano, Francesco T.; Mapstone, Timothy B.; McComb, J. Gordon; Menezes, Arnold H.; Muhlbauer, Michael; Oakes, W. Jerry; Olavarria, Greg; O’Neill, Brent R.; Park, Tae Sung; Ragheb, John; Selden, Nathan R.; Shah, Manish N.; Shannon, Chevis; Shimony, Joshua S.; Smith, Jodi; Smyth, Matthew D.; Stone, Scellig S.D.; Strahle, Jennifer M.; Tamber, Mandeep S.; Torner, James C.; Tuite, Gerald F.; Wait, Scott D.; Wellons, John C., III.; Whitehead, William E.; Limbrick, David D., Jr.; Neurological Surgery, School of Medicine
    Background: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. Objective: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. Methods: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. Results: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P < .001) were increased within the OCF group, whereas only basilar invagination (1/4, P < .001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P = .008) and OCF/VD (115.0 ± 11.6°, P = .025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups. Conclusion: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.
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    The role of occipital condyle and atlas anomalies on occipital cervical fusion outcomes in Chiari malformation type I with syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium
    (American Association of Neurological Surgeons, 2024-04-05) Yahanda, Alexander T.; Koueik, Joyce; Ackerman, Laurie L.; Adelson, P. David; Albert, Gregory W.; Aldana, Philipp R.; Alden, Tord D.; Anderson, Richard C. E.; Bauer, David F.; Bethel-Anderson, Tammy; Bierbrauer, Karin; Brockmeyer, Douglas L.; Chern, Joshua J.; Couture, Daniel E.; Daniels, David J.; Dlouhy, Brian J.; Durham, Susan R.; Ellenbogen, Richard G.; Eskandari, Ramin; Fuchs, Herbert E.; Grant, Gerald A.; Graupman, Patrick C.; Greene, Stephanie; Greenfield, Jeffrey P.; Gross, Naina L.; Guillaume, Daniel J.; Hankinson, Todd C.; Heuer, Gregory G.; Iantosca, Mark; Iskandar, Bermans J.; Jackson, Eric M.; Jallo, George I.; Johnston, James M.; Kaufman, Bruce A.; Keating, Robert F.; Khan, Nickalus R.; Krieger, Mark D.; Leonard, Jeffrey R.; Maher, Cormac O.; Mangano, Francesco T.; Martin, Jonathan; McComb, J. Gordon; McEvoy, Sean D.; Meehan, Thanda; Menezes, Arnold H.; Muhlbauer, Michael S.; O'Neill, Brent R.; Olavarria, Greg; Ragheb, John; Selden, Nathan R.; Shah, Manish N.; Shannon, Chevis N.; Shimony, Joshua S.; Smyth, Matthew D.; Stone, Scellig S. D.; Strahle, Jennifer M.; Tamber, Mandeep S.; Torner, James C.; Tuite, Gerald F.; Tyler-Kabara, Elizabeth C.; Wait, Scott D.; Wellons, John C.; Whitehead, William E.; Park, Tae Sung; Limbrick, David D.; Ahmed, Raheel; Neurological Surgery, School of Medicine
    Objective: Congenital anomalies of the atlanto-occipital articulation may be present in patients with Chiari malformation type I (CM-I). However, it is unclear how these anomalies affect the biomechanical stability of the craniovertebral junction (CVJ) and whether they are associated with an increased incidence of occipitocervical fusion (OCF) following posterior fossa decompression (PFD). The objective of this study was to determine the prevalence of condylar hypoplasia and atlas anomalies in children with CM-I and syringomyelia. The authors also investigated the predictive contribution of these anomalies to the occurrence of OCF following PFD (PFD+OCF). Methods: The authors analyzed the prevalence of condylar hypoplasia and atlas arch anomalies for patients in the Park-Reeves Syringomyelia Research Consortium database who underwent PFD+OCF. Condylar hypoplasia was defined by an atlanto-occipital joint axis angle (AOJAA) ≥ 130°. Atlas assimilation and arch anomalies were identified on presurgical radiographic imaging. This PFD+OCF cohort was compared with a control cohort of patients who underwent PFD alone. The control group was matched to the PFD+OCF cohort according to age, sex, and duration of symptoms at a 2:1 ratio. Results: Clinical features and radiographic atlanto-occipital joint parameters were compared between 19 patients in the PFD+OCF cohort and 38 patients in the PFD-only cohort. Demographic data were not significantly different between cohorts (p > 0.05). The mean AOJAA was significantly higher in the PFD+OCF group than in the PFD group (144° ± 12° vs 127° ± 6°, p < 0.0001). In the PFD+OCF group, atlas assimilation and atlas arch anomalies were identified in 10 (53%) and 5 (26%) patients, respectively. These anomalies were absent (n = 0) in the PFD group (p < 0.001). Multivariate regression analysis identified the following 3 CVJ radiographic variables that were predictive of OCF occurrence after PFD: AOJAA ≥ 130° (p = 0.01), clivoaxial angle < 125° (p = 0.02), and occipital condyle-C2 sagittal vertical alignment (C-C2SVA) ≥ 5 mm (p = 0.01). A predictive model based on these 3 factors accurately predicted OCF following PFD (C-statistic 0.95). Conclusions: The authors' results indicate that the occipital condyle-atlas joint complex might affect the biomechanical integrity of the CVJ in children with CM-I and syringomyelia. They describe the role of the AOJAA metric as an independent predictive factor for occurrence of OCF following PFD. Preoperative identification of these skeletal abnormalities may be used to guide surgical planning and treatment of patients with complex CM-I and coexistent osseous pathology.