Tags

Type your tag names separated by a space and hit enter

Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis.
J Neurosurg Pediatr. 2008 Jul; 2(1):42-9.JN

Abstract

OBJECT

Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children.

METHODS

The authors searched Medline-Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000-2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years.

RESULTS

Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08-0.69) and a higher rate of cerebrospinal fluid-related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53-23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95-1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91-2.25) were noted between PFDD and PFD.

CONCLUSIONS

Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid-related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.

Authors+Show Affiliations

Department of Surgery (Pediatric Neurosurgery), Dartmouth Medical School, Hanover, NH, USA. srd@hitchcock.orgNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

18590394

Citation

Durham, Susan R., and Kristina Fjeld-Olenec. "Comparison of Posterior Fossa Decompression With and Without Duraplasty for the Surgical Treatment of Chiari Malformation Type I in Pediatric Patients: a Meta-analysis." Journal of Neurosurgery. Pediatrics, vol. 2, no. 1, 2008, pp. 42-9.
Durham SR, Fjeld-Olenec K. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr. 2008;2(1):42-9.
Durham, S. R., & Fjeld-Olenec, K. (2008). Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis. Journal of Neurosurgery. Pediatrics, 2(1), 42-9. https://doi.org/10.3171/PED/2008/2/7/042
Durham SR, Fjeld-Olenec K. Comparison of Posterior Fossa Decompression With and Without Duraplasty for the Surgical Treatment of Chiari Malformation Type I in Pediatric Patients: a Meta-analysis. J Neurosurg Pediatr. 2008;2(1):42-9. PubMed PMID: 18590394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis. AU - Durham,Susan R, AU - Fjeld-Olenec,Kristina, PY - 2008/7/2/pubmed PY - 2008/7/30/medline PY - 2008/7/2/entrez SP - 42 EP - 9 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 2 IS - 1 N2 - OBJECT: Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. METHODS: The authors searched Medline-Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000-2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years. RESULTS: Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08-0.69) and a higher rate of cerebrospinal fluid-related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53-23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95-1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91-2.25) were noted between PFDD and PFD. CONCLUSIONS: Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid-related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia. SN - 1933-0707 UR - https://www.unboundmedicine.com/medline/citation/18590394/Comparison_of_posterior_fossa_decompression_with_and_without_duraplasty_for_the_surgical_treatment_of_Chiari_malformation_Type_I_in_pediatric_patients:_a_meta_analysis_ L2 - https://thejns.org/doi/10.3171/PED/2008/2/7/042 DB - PRIME DP - Unbound Medicine ER -