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. 2019 Oct;35(10):1777-1783.
doi: 10.1007/s00381-019-04226-9. Epub 2019 Jun 7.

The Seow Operative Score (SOS) as a decision-making adjunct for paediatric Chiari I malformation: a preliminary study

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The Seow Operative Score (SOS) as a decision-making adjunct for paediatric Chiari I malformation: a preliminary study

Sharon Y Y Low et al. Childs Nerv Syst. 2019 Oct.

Abstract

Purpose: The natural history of Chiari I malformation (C1M) in the paediatric population is poorly understood. There are conflicting reports with regards to surgical indications, operative techniques and peri-operative prognostic indicators. In this paper, we report our institutional experience in the management of paediatric C1M.

Methods: The workflow process which includes preferred imaging modalities, surgical techniques and indications for intervention is discussed. In particular, we describe one of our current projects-an in-house designed Seow Operative Score (SOS) as a feasibility scoring system for neurosurgical intervention in our local cohort of paediatric C1M patients.

Results: In our series, we have 2 groups: 10 non-operated patients versus 19 operated patients. In the non-operated group, the majority of patients had a SOS of 0 to 1. One patient had a score of 2.5 and was kept under close surveillance. Follow-up imaging demonstrated resolution of the cerebellar herniation and intraspinal syrinx. In the operated group, 17 patients had a SOS of 3 or more. Two patients had a SOS of 2. For these 2, 1 developed progressive symptoms, and the other had an extensive cervico-thoracic syrinx. Decision was made for surgery after a period of surveillance.

Conclusions: In this paper, we report our institutional experience in managing paediatric C1M and, at the same time, highlight salient points of our practices. Meanwhile, we advocate collective global efforts and in-depth research for better disease understanding of this challenging condition.

Keywords: Chiari I malformation; Suboccipital decompression.

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