Mapping the neurocognitive landscape of pediatric Chiari malformation type I: a scoping review of the literature.

Overview

Due to advancements in neuroimaging, Chiari malformation type I (CM-I) has become more widely recognized in pediatric populations. While its neurological manifestations are well documented, research on its neurocognitive impact remains limited and poorly characterized. This scoping review facilitates a comprehensive mapping of the current evidence, identifies the neurocognitive domains most frequently assessed, evaluates the extent of available evidence regarding surgical outcomes, and highlights critical knowledge gaps. The most frequently examined domains were working memory, executive function, language, and attention. Parental reports commonly indicated executive dysfunction, particularly within metacognitive processes. Evidence linking surgical decompression to improvements in neurocognitive function was inconsistent, and most studies lacked baseline or longitudinal assessments. Across studies, substantial methodological heterogeneity and variable use of validated instruments limited cross-comparison. Current evidence on the neurocognitive sequelae of pediatric CM-I is fragmented and methodologically diverse. The findings underscore the need for standardized neurocognitive assessments at diagnosis, the use of validated pediatric instruments, and prospective, longitudinal research integrating clinical, neuroimaging, and neurocognitive data to clarify the developmental impact of CM-I and its management.