Hi, my name is John Cheh. I'm a fourth year medical student at Weill Cornell, currently doing a research here under the mentorship of Dr. Greenfield, and today my talk is about revision Chiari surgery in young children, looking at their predictors and outcomes. So within this Chiari patient population, these young children aged zero to six years compose a very challenging group of patients to manage. There have only been a few case series in the literature, and these patients often present with atypical symptoms, and they frequently require revision surgeries. So the goal of our study was to analyze their clinical characteristics and to better understand the role of revision surgeries. So we did a retrospective review of patients aged six years or younger who were diagnosed with Chiari malformations and subsequently treated with posterior fossa decompression. Our first objective was to look at predictors of revision surgery by comparing the no revision group and the revision group, and our subsequent objectives were looking at reasons for reoperation and looking at postoperative outcomes. You can see on the graph on the left that the top three overall presenting symptoms were headache, dysphagia, and respiratory problems, and for all three of these problems, they were much more common in the revision group compared to the no revision group, but these were not statistically significant, likely because we were underpowered. But on the right, you see dysautonomia selectively, and you can see that this was much more common in the revision group compared to the no revision group, and this difference was statistically significant, suggesting that dysautonomia may be a predictor of revision surgery. Next, we looked at reasons for reoperation. These reasons were not mutually exclusive, and the most common reason was symptom recurrence, and the other reasons were residual dorsal compression and suspicion for significant scar tissue on MRI. One patient didn't have any resolution of symptoms after surgery, and two patients had other issues going on. So one patient had ventral brainstem compression requiring subsequent odontoresection, and another patient had suspected craniosurficial instability requiring an OC fusion. Next, looking at outcomes postoperatively. So after surgery number two, five out of eight patients had complete resolution or significant improvement long-term after surgery, and three patients had relatively unchanged outcomes after the surgery. So out of these three patients, two of them underwent surgery number three, after which one patient had resolution-slash-improvement, and the other patient had, again, unchanged symptoms. So this last patient did undergo surgery number four, and while this patient had 12 months of symptom improvement, after this sort of one-year mark, all the symptoms recurred. And this kind of suggests that there might be a point of diminishing returns after multiple surgeries. So several conclusions can be drawn from our study. So consistent with the literature, oropharyngeal and respiratory problems are particularly common in this Kiari age group. And out of sort of different preoperative variables, this autonomia stood out as a possible predictor for reoperation, and symptom recurrence is the most common reason for reoperation. And these revision surgeries tend to lead to improved clinical outcomes, given that they address the underlying issues. So it is really important to bring up this topic of revision surgery in the initial discussion with patients and their family members. So I would like to thank Dr. Greenfield for his phenomenal mentorship, and Erica, who is our Kiari Care Coordinator. Thank you so much.

revision Chiari surgery

young children

atypical symptoms

revision surgeries

clinical characteristics