Efficacy of neurosurgical intervention in syrinx resolution in patients presenting with Chiari malformation type I and syringomyelia: a systematic review and radiological meta-analysis
Bibliographic record
Abstract
Neurosurgical techniques have been used to treat Chiari Malformation type 1 (CM1). However, there remains some uncertainty regarding which neurosurgical procedure is most efficacious in treating patients with CMI and syringomyelia. Our study aims to compare the efficacy of available neurosurgical techniques in resolving syrinx for patients with CM1 and syringomyelia. Included studies must report both pre-and post-operative syrinx measurements, discuss the use of nurosurgery, and involve patients with CM1 and syringomyelia. Studies with less than 5 patients were excluded. Databases used to identify studies included PubMed, Scopus, Cochrane Library, Web of Science, and Ovid. The Newcastle-Ottawa Scale, Joanna Briggs Institute checklist, and the Risk of Bias 2 analysis tools assesed the risk of bias in the study. A meta-analysis was conducted using a random-effects model, and forest plots illustrated the results. A total of 20 studies involving 3,063 patients with CM1 and syringomyelia were included in the study. Posterior fossa decompression with duraplasty (PFDD) demonstrated significant syrinx reduction: syrinx width (SW) reduced by a mean difference (MD) of 2.46 mm (95% CI: 2.16-2.76), syrinx length by 1.68 vertebral segments (95% CI: 1.44-1.92), and syrinx-to-cord ratio by 0.21( 95% CI: 0.15 to 0.26). Posterior fossa decompression with tonsillar reduction (PFDTR) had significantly reduced SW (MD: 2.85 mm, 95% CI: 1.99-3.71). It was superior to PFDD in the syrinx-to-cord ratio (MD: 0.04, 95% confidence interval (CI) of 0.01 to 0.08). Fourth ventricular stents (FVS) and syringo-subarachnoid shunts (SSS) were other reported techniques, but there were insufficient studies for formal analysis. PFDD and PFDRT are both efficacious in reducing syrinx size in patients with CM1 and syringomyelia. PDRT displayed modest superiority in syrinx resolution, and the clinical significance of this is limited. More studies are needed to determine the efficacy of FVS and SSS.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.009 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".