BACKGROUND: Dural splitting decompression may be an effective and safe treatment for Chiari I malformation. OBJECTIVE: To compare clinical outcomes, complications, and resource utilization for patients undergoing Chiari I decompression with or without duraplasty. METHODS: Between 2000 and 2009, the senior author performed 113 Chiari I decompression operations with dural splitting or duraplasty in children less than 18 years of age; 110 were included in a retrospective cohort analysis of safety, efficacy, and treatment cost. Patients without significant syringomyelia underwent dural splitting decompression, and patients with syringomyelia underwent duraplasty. RESULTS: : Sixty-three patients without significant syringomyelia (57%) underwent dural splitting decompression. They were significantly younger than patients undergoing duraplasty (8.3 ± 4.9 years vs 10.4 ± 4.4 years; P < .05). Headaches improved or resolved in most patients in both groups (90.5% vs 93.6%; P = .59). Dysphagia, long tract signs, cranial nerve, and bulbar symptoms also improved similarly in both groups. Three duraplasty patients were treated medically for aseptic meningitis; one underwent reoperation for a symptomatic pseudomeningocele. No patient undergoing dural splitting decompression experienced a cerebrospinal fluid-related complication. Extradural decompression required less operative time than duraplasty (105.5 vs 168.9 minutes, P < .001), a shorter length of stay (2.4 vs 2.8 days, P = .011), and lower total cost for the primary hospitalization ($26 837 vs $29 862, P = .015). CONCLUSION: In this retrospective cohort study, dural splitting decompression was equally effective, safer, and lower cost for treatment of Chiari I malformation without syringomyelia. A multicenter trial with groups balanced for the presence of syringomyelia is necessary to determine whether these results are generalizable.
BACKGROUND: Dural splitting decompression may be an effective and safe treatment for Chiari I malformation. OBJECTIVE: To compare clinical outcomes, complications, and resource utilization for patients undergoing Chiari I decompression with or without duraplasty. METHODS: Between 2000 and 2009, the senior author performed 113 Chiari I decompression operations with dural splitting or duraplasty in children less than 18 years of age; 110 were included in a retrospective cohort analysis of safety, efficacy, and treatment cost. Patients without significant syringomyelia underwent dural splitting decompression, and patients with syringomyelia underwent duraplasty. RESULTS: : Sixty-three patients without significant syringomyelia (57%) underwent dural splitting decompression. They were significantly younger than patients undergoing duraplasty (8.3 ± 4.9 years vs 10.4 ± 4.4 years; P < .05). Headaches improved or resolved in most patients in both groups (90.5% vs 93.6%; P = .59). Dysphagia, long tract signs, cranial nerve, and bulbar symptoms also improved similarly in both groups. Three duraplasty patients were treated medically for aseptic meningitis; one underwent reoperation for a symptomatic pseudomeningocele. No patient undergoing dural splitting decompression experienced a cerebrospinal fluid-related complication. Extradural decompression required less operative time than duraplasty (105.5 vs 168.9 minutes, P < .001), a shorter length of stay (2.4 vs 2.8 days, P = .011), and lower total cost for the primary hospitalization ($26 837 vs $29 862, P = .015). CONCLUSION: In this retrospective cohort study, dural splitting decompression was equally effective, safer, and lower cost for treatment of Chiari I malformation without syringomyelia. A multicenter trial with groups balanced for the presence of syringomyelia is necessary to determine whether these results are generalizable.
Authors: Braden J Lawrence; Mark Luciano; John Tew; Richard G Ellenbogen; John N Oshinski; Francis Loth; Amanda P Culley; Bryn A Martin Journal: World Neurosurg Date: 2018-05-04 Impact factor: 2.104
Authors: Benjamin C Kennedy; Kathleen M Kelly; Michelle Q Phan; Samuel S Bruce; Michael M McDowell; Richard C E Anderson; Neil A Feldstein Journal: J Neurosurg Pediatr Date: 2015-05-01 Impact factor: 2.375
Authors: Jared M Pisapia; Maxwell B Merkow; Danielle Brewington; Rosemary E Henn; Leslie N Sutton; Phillip B Storm; Gregory G Heuer Journal: Childs Nerv Syst Date: 2016-12-05 Impact factor: 1.475
Authors: Amy Lee; Chester K Yarbrough; Jacob K Greenberg; Jason Barber; David D Limbrick; Matthew D Smyth Journal: Childs Nerv Syst Date: 2014-04-29 Impact factor: 1.475