2026 Poster Presentations
P065: REVISION SURGERY FOR RECURRENT STENOSIS DUE TO BONE REGROWTH AFTER DECOMPRESSION IN CHILDREN WITH SYNDROMIC CHIARI TYPE I MALFORMATION
Christoph Wipplinger, MD1; Stefan Rückriegel, MD2; Annika Stock, MD2; Tamara M Wipplinger, MSc2; Felipe Monteiro, MD1; Alejandro N Santos, MD3; Camelia Monoranu, MD2; Hamid Borghei-Razavi, MD1; Tilmann Schweitzer, MD2; 1Cleveland Clinic Florida; 2University Hospital of Würzburg; 3Department of Neurosurgery, Miller School of Medicine
Objective: We present a single center retrospective analysis of pediatric patients treated for syndromic and non-syndromic CM-I with a particular focus on reoperation rates and a nuanced investigation of rare complications including bone regrowth as this is scarcely reported in the current literature.
Methods: A retrospective analysis of all patients treated surgically for Chiari malformation in the authors’ institution between 2008 and 2023 was performed. The study included all patients with CM-I under 18. Baseline demographics, operative technique, interoperative findings, and revision surgeries were recorded.
Results: Thirty-seven patients were included (13 syndromic CM-I, 24 non-syndromic CM-I). Most (57%) underwent bony decompression with dural opening, tonsillar reduction, and duraplasty. Reoperation was required in seven patients (19%): Six due to bone regrowth causing restenosis and one due to fibrous tissue overgrowth. Importantly, all bone regrowth cases occurred in syndromic patients, several with prior ventriculoperitoneal shunting.
Conclusions: In this single-center series, all cases of restenosis due to bone regrowth occurred exclusively in patients with syndromic craniosynostosis, and in the context of ventriculoperitoneal shunting. These findings suggest that syndromic craniosynostosis patients represent a high-risk subgroup in whom restenosis after Chiari decompression is more likely. We therefore recommend intensified and prolonged clinical and imaging follow-up for this population to enable early detection and timely reoperation when necessary.