Building consensus regarding the definition of abnormal craniocervical motion in pediatric patients with Chiari malformation: a modified Delphi study.

Abstract

Objective: Abnormal craniocervical motion (ACCM) in the setting of pediatric Chiari type 1 and 1.5 malformation (CM-1/1.5) is generally regarded to be uncommon. The focus of this modified Delphi study was to investigate and build consensus regarding the definition of ACCM in pediatric patients with CM-1/1.5 and the clinical and radiographic methods to identify it.

Methods: An international group of 14 pediatric neurosurgeons with clinical and research expertise in the management of CM was asked to participate. The study focused only on ACCM in the setting of CM-1 and excluded other types of CM. An initial survey of current practices was administered, and based on these responses, a follow-up survey of potential consensus statements was distributed. Consensus was defined as ≥ 80% of participants reaching agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A final hybrid virtual/in-person meeting was held for discussion and to generate final consensus statements.

Results: Following the final Delphi round, 22 statements reached consensus following discussion and modification of previous statements. Statements that reached consensus included the identification of patient populations that may benefit from screening, recommended imaging for screening along with useful radiographic parameters, and a consideration of trial cervical immobilization in symptomatic patients with supportive imaging. An additional modification to all statements emphasizing the focus on ACCM was agreed upon. All participants stated that they would be willing or somewhat willing to change their practices based on consensus guidelines.

Conclusions: In this study, an international group of pediatric neurosurgeons reached consensus on 22 expert opinion-based statements regarding ACCM in pediatric patients with CM-1. Further study using a standardized approach to screening may facilitate a better understanding of the true incidence and impact of ACCM in CM-1.