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Abstract
We reviewed the recent experience at Texas Children's Hospital by examining the records
of 11 children who underwent suboccipital decompression for symptomatic Chiari type
I malformation. Presenting complaints included neck pain (1 child), scoliosis (4 children),
back pain (1 child), torticollis (1), motor dysfunction (1), and apnea (3 children).
Neurologic findings were normal in 7 of the 11 children. The craniocervical junction
and medulla were studied by magnetic resonance imaging, which revealed anatomy consistent
with Chiari type I malformation in all cases. At surgery, all patients had tonsillar
herniation to the first cervical vertebra or below. Three patients had syringomyelia.
Postoperatively, either the patients were symptom free or, in the cases of scoliosis
and torticollis, there was no progression. Our experience suggests that Chiari type
I malformation may occur in childhood with varied and unusual clinical findings. Magnetic
resonance imaging was essential to the diagnosis; the presence of tonsillar herniation
was confirmed at surgery. The results of suboccipital decompression were favorable
in this series.