SynthesisNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Intraoperative ultrasonography in the surgical management of Chiari I malformation: A systematic review and meta-analysis of outcomes and applications.
Synthesis in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChiari malformation type I (CM-I) is a neurological disorder characterized by cerebellar tonsillar herniation and is often associated with syringomyelia. Posterior fossa decompression (PFD) is the primary treatment, although the optimal extent of decompression remains a topic of debate. Intraoperative ultrasonography (IOUS) offers real-time visualization to support informed surgical decision-making. This study aimed to assess the effectiveness and safety of IOUS-guided surgery in CM-I.
methodsThis systematic review followed PRISMA guidelines and searched the literature up to July 5, 2025. Studies that utilized IOUS and reported related outcomes were included. A random-effects meta-analysis was employed to pool proportions, and a meta-regression analysis was conducted to explore heterogeneity.
resultsTwenty-one non-randomized observational studies, including 1,576 patients, 54.4% of whom were female, were included. The pooled clinical improvement rate was 88% (95% CI: 81%–93%), and the syrinx improvement/resolution rate was 87% (95% CI: 77%–95%). The pooled reoperation rate was 6% (95% CI: 3%–9%), and the complication rate was 6% (95% CI: 3%–8%). Meta-regression revealed that longer disease duration, motor/sensory deficits, and duraplasty were associated with improved syrinx outcomes.
conclusionIOUS-guided surgery in CM-I is linked to positive clinical and radiological improvements and low complication rates. IOUS can serve as a helpful tool for customizing decompression during CM-I surgery. Larger, prospective, multi-center studies are needed to confirm these findings.
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