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Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome.
J Neurosurg. 2004 Nov; 101(2 Suppl):184-8.JN

Abstract

OBJECT

The choice of surgical technique for decompressive surgery in patients with Chiari I malformation is controversial. Good preliminary postoperative outcomes have been achieved in patients with Chiari I malformation (without syringomyelia) after using a dura-splitting technique. The authors evaluated safety, resource use, and early outcome after this surgery in patients without syringomyelia and compared the findings associated with duraplasty in patients with syringomyelia.

METHODS

A prospective series of 24 patients with Chiari I malformation (12 with a syrinx) underwent decompression of the craniocervical junction (CCJ). An allograft-augmented duraplasty was performed in patients with syringomyelia. Intraoperative ultrasonography confirmed adequate tonsillar decompression after lysis of the periosteal bands at the foramen magnum and C-1 arch as well as partial resection of the outer leaf of the dura in patients without syringomyelia. Patients in each group were of similar mean age (syringomyelia 10.8 years and no syringomyelia 7.6 years old; p = 0.07) and functional status. The mean follow-up period was 15.3 months (range 3-30 months). Dura-splitting decompression required significantly less mean operative time (99 minutes compared with 169 minutes, respectively; p < 0.001), total operating room time (166 minutes compared with 249 minutes, respectively; p < 0.001), duration of hospitalization (3 days compared with 3.75 days, respectively; p < 0.05), perioperative charges ($3615 compared with $5538, respectively; p < 0.001), and overall hospital charges ($7705 compared with $9759, respectively; p < 0.001) than the duraplasty. Mean clinical outcome scores were similar (syringomyelia 1.53 of 2; no syringomyelia 1.67 of 2; not statistically significant).

CONCLUSIONS

Dura-splitting CCJ decompression in pediatric patients with Chiari I malformation and without syringomyelia is safe, provides good early clinical results, and significantly reduces resource use. A randomized controlled trial of dura-splitting decompression in a uniform population of patients with Chiari I malformation is indicated.

Authors+Show Affiliations

Division of Pediatric Neurosurgery, Doernbecher Children's Hospital and Oregon Health & Science University, Portland, Oregon 97239, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15835106

Citation

Limonadi, Farhad M., and Nathan R. Selden. "Dura-splitting Decompression of the Craniocervical Junction: Reduced Operative Time, Hospital Stay, and Cost With Equivalent Early Outcome." Journal of Neurosurgery, vol. 101, no. 2 Suppl, 2004, pp. 184-8.
Limonadi FM, Selden NR. Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. J Neurosurg. 2004;101(2 Suppl):184-8.
Limonadi, F. M., & Selden, N. R. (2004). Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. Journal of Neurosurgery, 101(2 Suppl), 184-8.
Limonadi FM, Selden NR. Dura-splitting Decompression of the Craniocervical Junction: Reduced Operative Time, Hospital Stay, and Cost With Equivalent Early Outcome. J Neurosurg. 2004;101(2 Suppl):184-8. PubMed PMID: 15835106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. AU - Limonadi,Farhad M, AU - Selden,Nathan R, PY - 2005/4/20/pubmed PY - 2005/6/17/medline PY - 2005/4/20/entrez SP - 184 EP - 8 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 101 IS - 2 Suppl N2 - OBJECT: The choice of surgical technique for decompressive surgery in patients with Chiari I malformation is controversial. Good preliminary postoperative outcomes have been achieved in patients with Chiari I malformation (without syringomyelia) after using a dura-splitting technique. The authors evaluated safety, resource use, and early outcome after this surgery in patients without syringomyelia and compared the findings associated with duraplasty in patients with syringomyelia. METHODS: A prospective series of 24 patients with Chiari I malformation (12 with a syrinx) underwent decompression of the craniocervical junction (CCJ). An allograft-augmented duraplasty was performed in patients with syringomyelia. Intraoperative ultrasonography confirmed adequate tonsillar decompression after lysis of the periosteal bands at the foramen magnum and C-1 arch as well as partial resection of the outer leaf of the dura in patients without syringomyelia. Patients in each group were of similar mean age (syringomyelia 10.8 years and no syringomyelia 7.6 years old; p = 0.07) and functional status. The mean follow-up period was 15.3 months (range 3-30 months). Dura-splitting decompression required significantly less mean operative time (99 minutes compared with 169 minutes, respectively; p < 0.001), total operating room time (166 minutes compared with 249 minutes, respectively; p < 0.001), duration of hospitalization (3 days compared with 3.75 days, respectively; p < 0.05), perioperative charges ($3615 compared with $5538, respectively; p < 0.001), and overall hospital charges ($7705 compared with $9759, respectively; p < 0.001) than the duraplasty. Mean clinical outcome scores were similar (syringomyelia 1.53 of 2; no syringomyelia 1.67 of 2; not statistically significant). CONCLUSIONS: Dura-splitting CCJ decompression in pediatric patients with Chiari I malformation and without syringomyelia is safe, provides good early clinical results, and significantly reduces resource use. A randomized controlled trial of dura-splitting decompression in a uniform population of patients with Chiari I malformation is indicated. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/15835106/Dura_splitting_decompression_of_the_craniocervical_junction:_reduced_operative_time_hospital_stay_and_cost_with_equivalent_early_outcome_ L2 - https://thejns.org/doi/10.3171/ped.2004.101.2.0184 DB - PRIME DP - Unbound Medicine ER -