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Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I.
Clin Neurol Neurosurg. 2014 Oct; 125:182-8.CN

Abstract

INTRODUCTION

Chiari malformation-I (CM) is one of the most controversial entities in the contemporary neurosurgical literature. Posterior fossa decompression (PFD) is the preferred treatment for CM with and without syringomyelia. A variety of surgical techniques for PFD have been advocated in the literature. The aim of this study was to evaluate our results of surgically treated patients for CM-I with and without syringomyelia; using extradural dura-splitting and intradural intraarachnoid techniques.

METHODS

A retrospective review of the medical records of all the patients undergoing PFD was conducted. Symptomatic patients with tonsillar herniation≥3-mm below the foramen magnum on neuroimaging, and CSF flow void study demonstrating restricted or no CSF flow at the craniocervical junction, were offered surgical treatment. In patients without syringomyelia, extradural decompression with thinning of the sclerotic tissue at the cervicomedullary junction and splitting of outer dural layer was performed. In patients with syringomyelia, the dura was opened and an expansile duraplasty was performed.

RESULTS

The mean age of 8 males and 34 females was 33.8 years (range, 16-58 years). Headache (39/41; 95%), and/or tingling and numbness (17/41; 42%) were the most common presenting symptoms. The syrinx was associated with CM-I in 5/41 (12%) patients. PFD without durotomy was performed in 29/41 (73%) patients. The mean duration of preoperative symptoms was significantly longer in duraplasty group (4.6 versus 1.7 years, P=0.005, OR=0.48, CI=0.29-0.8). The use of duraplasty was significantly associated with presence of complications (P=0.004, OR=0.5, CI=0.3-0.8) and longer duration of hospital stay (P=0.03, OR=2.7, CI=1.1-6.8). The overall complication rate was 6/41(15%) patients. The overall improvement rate was evident in 84% (36/41); 12% (5/41) were stable; and 5% (2/41) had worsening of symptoms. The history of prior CM decompression was associated with unfavorable outcomes (P=0.04, OR=14, CI=1.06-184). One patient experienced recurrence one year after the PFD with duraplasty.

CONCLUSION

The present study reports favorable surgical outcomes with extra-dural decompression of the posterior fossa in patients CM-I without syringomyelia. For patients with syringomyelia and history of prior PFD, intradural intra-arachnoid decompression is required. The prior history of decompression was associated with unfavorable outcomes. The use of duraplasty was associated with longer duration of hospital stay and higher complication rate. Further large cohort prospective study is needed to provide any recommendation on the indication of intra or extradural decompression for a given CM-I patient.

Authors+Show Affiliations

Division of Neurosurgery, Department of Surgery, University of Toledo Medical Center, Toledo, USA.Division of Neurosurgery, Department of Surgery, University of Toledo Medical Center, Toledo, USA. Electronic address: azedine.medhkour@utoledo.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25171392

Citation

Chotai, Silky, and Azedine Medhkour. "Surgical Outcomes After Posterior Fossa Decompression With and Without Duraplasty in Chiari Malformation-I." Clinical Neurology and Neurosurgery, vol. 125, 2014, pp. 182-8.
Chotai S, Medhkour A. Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I. Clin Neurol Neurosurg. 2014;125:182-8.
Chotai, S., & Medhkour, A. (2014). Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I. Clinical Neurology and Neurosurgery, 125, 182-8. https://doi.org/10.1016/j.clineuro.2014.07.027
Chotai S, Medhkour A. Surgical Outcomes After Posterior Fossa Decompression With and Without Duraplasty in Chiari Malformation-I. Clin Neurol Neurosurg. 2014;125:182-8. PubMed PMID: 25171392.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I. AU - Chotai,Silky, AU - Medhkour,Azedine, Y1 - 2014/08/12/ PY - 2014/06/09/received PY - 2014/07/08/revised PY - 2014/07/20/accepted PY - 2014/8/30/entrez PY - 2014/8/30/pubmed PY - 2015/8/20/medline KW - Chiari malformation KW - Dura-splitting KW - Extra-dural KW - Intradural KW - Syringomyelia SP - 182 EP - 8 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 125 N2 - INTRODUCTION: Chiari malformation-I (CM) is one of the most controversial entities in the contemporary neurosurgical literature. Posterior fossa decompression (PFD) is the preferred treatment for CM with and without syringomyelia. A variety of surgical techniques for PFD have been advocated in the literature. The aim of this study was to evaluate our results of surgically treated patients for CM-I with and without syringomyelia; using extradural dura-splitting and intradural intraarachnoid techniques. METHODS: A retrospective review of the medical records of all the patients undergoing PFD was conducted. Symptomatic patients with tonsillar herniation≥3-mm below the foramen magnum on neuroimaging, and CSF flow void study demonstrating restricted or no CSF flow at the craniocervical junction, were offered surgical treatment. In patients without syringomyelia, extradural decompression with thinning of the sclerotic tissue at the cervicomedullary junction and splitting of outer dural layer was performed. In patients with syringomyelia, the dura was opened and an expansile duraplasty was performed. RESULTS: The mean age of 8 males and 34 females was 33.8 years (range, 16-58 years). Headache (39/41; 95%), and/or tingling and numbness (17/41; 42%) were the most common presenting symptoms. The syrinx was associated with CM-I in 5/41 (12%) patients. PFD without durotomy was performed in 29/41 (73%) patients. The mean duration of preoperative symptoms was significantly longer in duraplasty group (4.6 versus 1.7 years, P=0.005, OR=0.48, CI=0.29-0.8). The use of duraplasty was significantly associated with presence of complications (P=0.004, OR=0.5, CI=0.3-0.8) and longer duration of hospital stay (P=0.03, OR=2.7, CI=1.1-6.8). The overall complication rate was 6/41(15%) patients. The overall improvement rate was evident in 84% (36/41); 12% (5/41) were stable; and 5% (2/41) had worsening of symptoms. The history of prior CM decompression was associated with unfavorable outcomes (P=0.04, OR=14, CI=1.06-184). One patient experienced recurrence one year after the PFD with duraplasty. CONCLUSION: The present study reports favorable surgical outcomes with extra-dural decompression of the posterior fossa in patients CM-I without syringomyelia. For patients with syringomyelia and history of prior PFD, intradural intra-arachnoid decompression is required. The prior history of decompression was associated with unfavorable outcomes. The use of duraplasty was associated with longer duration of hospital stay and higher complication rate. Further large cohort prospective study is needed to provide any recommendation on the indication of intra or extradural decompression for a given CM-I patient. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/25171392/Surgical_outcomes_after_posterior_fossa_decompression_with_and_without_duraplasty_in_Chiari_malformation_I_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(14)00287-X DB - PRIME DP - Unbound Medicine ER -