Yasser Seddeg Abdulghani, Mohammed Awad Elzain, Ali Awad Ali, Haytham Hussien Mohamed, Basheer Mohammed Basheer.
Chiari type-I malformation: Clinical features and surgical outcome assessment using Chicago Chiari Outcome Score (CCOS) among Sudanese patients.
Pak J Surg Jan ;35(4):325-30.

Background: Chiari malformation is one of the most controversial topics in neuro-surgery today. Th ere is no of agreement as to what define these malformations, their symptoms and their natural history. Chicago Chiari Outcome Score (CCOS) is a scoring system designed to study the surgical outcome of Chiari type-1 patients. Purpose: The purpose of the study aimed to assess patients with Chiari malformation type-1 in Sudan regarding their presenting symptoms, radiological findings, and surgical outcome for different surgical modalities and techniques. Material and Methods: This study was a prospective observational study done at different neuro-surgery centers in Khartoum during the period from February 2018- August 2019. The study included all Sudanese patients who underwent decompression surgery for Chiari-1 malformation with or without duraplasty during this period. Chicago Chiari Outcome Score (CCOS) was applied to evaluate post-surgical outcome. Results: 20 patients were found to satisfy inclusive and exclusive criteria for Chiari-1 malformation and were all operated (11 males and 9 females). Th e mean age was 33 years. Th e mean duration of symptoms was 19.8 months. Associated syringomyelia was detected in (18, 90%). All patients underwent posterior fossa decompression with or without removal of the posterior arch of C1, and with or without dura-plasty. Mean time for follow up was 4.45 months. Using the scoring system of CCOS, The outcome of the study group revealed in capacitated outcome (3, 15%), impaired outcome (6, 30%), functional outcome (9, 45%) and excellent outcome (2,10%). Patients without associated syringomyelia showed better outcome in comparison to patients with associated syringomyelia which was statistically significant (P = 0.008). Conclusion: This study provides evidence that early surgical intervention for Chiari-1 malformation before the development of delayed sever symptoms of the disease was associated with better outcome especially in those without associated syringomyelia.

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