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Posterior fossa decompression with duraplasty in Chiari malformation type 1: a systematic review and meta-analysis

  • Original Article - Neurosurgery general
  • Published:
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Abstract

Background

Surgery for symptomatic Chiari type I malformation (CM-I) patients include posterior fossa decompression (PFD) involving craniectomy with or without dural opening, and posterior fossa decompression with duraplasty (PFDD). This review aims to examine the evidence to aid surgical decision-making.

Methods

A medical database search was expanded to include article references to identify all relevant published case series. Animal studies, editorials, letters, and review articles were excluded. A systemic review and meta-analysis were performed to assess clinical and radiological improvement, complications, and reoperation rates.

Results

Seventeen articles, containing data on 3618 paediatric and adult participants, met the inclusion criteria. In the group, 5 papers included patients that had the dura left open. PFDD is associated with better clinical outcomes (RR 1.24, 95% CI, 1.07 to 1.44; P = 0.004), but has a higher complication rate (RR 4.51, 95% CI, 2.01 to 10.11; P = 0.0003). In adults, clinical outcomes differences did not reach statistical significance (P = 0.07) but re-operation rates were higher with PFD (RR 0.17, 95% CI 0.03 to 0.86; P = 0.03), whilst in children re-operation rates were no different (RR 0.97, 95% CI 0.41 to 2.30; P = 0.94). Patients with a syrinx did better with PFDD (P = 0.02). No significant differences were observed concerning radiological improvement.

Conclusions

In the absence of hydrocephalus and craniocervical region instability, PFDD provides better clinical outcomes but with higher risk. The use of PFD may be justified in some cases in children, and in the absence of a syrinx. To help with future outcome assessments in patients with a CM-I, standardization of clinical and radiological grading systems are required.

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Authors and Affiliations

  1. Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK

    Sharon Ka Po. Tam

  2. The Walton Centre, NHS Foundation Trust, Liverpool, UK

    Andrew Brodbelt

  3. Mount Sinai South Nassau, Chiari Neurosurgical Institute, Oceanside, NY, USA

    Paolo A. Bolognese

  4. Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

    Mansoor Foroughi

Authors
  1. Sharon Ka Po. Tam
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  2. Andrew Brodbelt
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  3. Paolo A. Bolognese
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  4. Mansoor Foroughi
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Correspondence to Sharon Ka Po. Tam.

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This article is part of the Topical Collection on Neurosurgery general

Presented under the title of Chiari malformation type 1: A review of literature to compare bony posterior fossa decompression with and without duraplasty at ABN / SBNS Joint Autumn Meeting

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Tam, S.K.P., Brodbelt, A., Bolognese, P.A. et al. Posterior fossa decompression with duraplasty in Chiari malformation type 1: a systematic review and meta-analysis. Acta Neurochir 163, 229–238 (2021). https://doi.org/10.1007/s00701-020-04403-9

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  • DOI: https://doi.org/10.1007/s00701-020-04403-9

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