Hi, everyone. My name is Eric Montgomery. I'm a medical student here at the University of Texas Southwestern in Dallas. I'd like to thank you for taking the time to listen to this talk. I'd also like to thank the ANS for providing a platform to share our work, even as we cannot meet together in Boston. We have nothing to disclose. So as many of you may know, the surgical treatment for a TRU1 malformation remains controversial. Recent trends support less invasive procedures as they result in similar clinical outcomes with less risk compared to more invasive procedures. However, much of the literature in this area focus on with and without duraplasty, and less attention is given to more invasive subdural procedures. Interestingly, in a recent paper in JNS Pediatrics, Kook and colleagues found that no difference in syrinx improvement between posterior faucet decompression with and without tonsillar reduction. This is a first-of-its-kind prospective trial with multiple centers, and we greatly look forward to their results. So our study was a retrospective review of 401 pediatric patients from May 2001 to May 2019. There were four treatment groups, bone decompression with and without duraplasty, bone decompression with arachnoid dissection or lysis, bone decompression with tonsillar coagulation, and bone decompression with cerebellar tonsillar resection. Some general demographics of our patients. There was a roughly 50-50 split between male and female with an average age of 8.3 years. The mean follow-up was 32 months, and here you can see the number of patients that fell in each treatment arm. So clinically, we found that the bone decompression resulted in improved symptoms 70% of the time. Bone decompression with arachnoid adhesion, dissection, or lysis resulted in improvement 88% of the time with symptoms. Bone decompression with tonsillar coagulation improved symptoms 85.5% of the time, and tonsillar resection improved 81.7% of the time. The differences in these rates of improvement was not statistically significant. As well, with searance improvement, we found that tonsillar resection improved searance 87.1% of the time, tonsillar coagulation 84.6% of the time, adhesion lysis 66.7% of the time, and bone decompression 60.6% of the time. Notably, the difference between tonsillar resection and bone decompression was statistically significant. Also importantly, we found that there was no statistical significance in the difference between complication rates or reoperation rates between the four different treatment groups. So overall, our data supports cerebellar tonsillar resection for the improved rate of searance improvement over other surgical techniques for QRA1, notably without higher complication rates. This is somewhat supported by recent meta-analyses. So Lynn et al. in 2018 found that bone decompression with duraplasty and or tonsillar reduction resulted in improved rates of searance improvement. However, this did not result in improved rates of symptom improvement, similar to as we found. On the other hand, Lou et al. in 2017 found that symptom improvement occurred with a greater rate with bone decompression and duraplasty or tonsillar reduction, whereas searance improvement was not statistically significant between the two treatment groups. Notably, their searance improvement arm had relatively few patients, and as more data comes out in this area, we hope that this will improve the power behind these numbers to determine whether it's statistically significant or not. So in conclusion, cerebellar tonsillar resection remains a viable option for the surgical treatment of QRA1 malformation and can be done in a safe manner. Much debate still remains on the surgical management of QRA1 malformation, and although recent support shows that less invasive procedures show similar outcomes to more invasive procedures with less risk, our series demonstrate that cerebellar tonsillar resection can be done in a safe manner and efficacious in the case of QRA1 malformation with searance. Thank you for your time.

TRU1 malformation

surgical treatment options

invasive procedures

tonsillar reduction

cerebellar tonsillar resection