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Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression with and without Duraplasty for Treatment of Pediatric Chiari I Malformation: A Prospective Study.
World Neurosurg. 2018 Feb; 110:e465-e472.WN

Abstract

OBJECTIVE

The aim of this study was to prospectively compare the radiographic and clinical outcomes between the posterior fossa decompression (PFD) and PFD with duraplasty (PFDD) procedures in adolescent patients with Chiari malformation type I (CMI).

METHODS

Ninety adolescent patients with CMI were randomly assigned to undergo either PFDD or PFD. In both groups, a dissection from the occipital bone was performed. The dura was not opened in the PFD group, and the outer layer of dura was resected. However, in the PFDD group, the dura mater was opened and expanded. Data were analyzed for clinical outcome, complications, and syrinx resolution.

RESULTS

The age, gender, and preoperative neurologic status were similar between the 2 groups. Compared with the PFD group, patients undergoing PFDD had significantly longer operation time, longer postoperative drainage time, and higher drainage volume. At the latest follow-up, no statistically significant difference was found between the 2 groups in terms of syrinx resolution. The clinical outcomes were similar in the PFDD and PFD group. Compared with the PFD group, patients in the PFDD group had a higher incidence of cerebrospinal fluid leak.

CONCLUSIONS

Compared with the more aggressive decompression with duraplasty, PFD without duraplasty produces comparable radiologic and clinical outcomes and is associated with a lower risk of complications.

Authors+Show Affiliations

Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Neurosurgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Neurosurgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: zhuzezhang@126.com.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29133007

Citation

Jiang, Enze, et al. "Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression With and Without Duraplasty for Treatment of Pediatric Chiari I Malformation: a Prospective Study." World Neurosurgery, vol. 110, 2018, pp. e465-e472.
Jiang E, Sha S, Yuan X, et al. Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression with and without Duraplasty for Treatment of Pediatric Chiari I Malformation: A Prospective Study. World Neurosurg. 2018;110:e465-e472.
Jiang, E., Sha, S., Yuan, X., Zhu, W., Jiang, J., Ni, H., Liu, Z., Qiu, Y., & Zhu, Z. (2018). Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression with and without Duraplasty for Treatment of Pediatric Chiari I Malformation: A Prospective Study. World Neurosurgery, 110, e465-e472. https://doi.org/10.1016/j.wneu.2017.11.007
Jiang E, et al. Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression With and Without Duraplasty for Treatment of Pediatric Chiari I Malformation: a Prospective Study. World Neurosurg. 2018;110:e465-e472. PubMed PMID: 29133007.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Clinical and Radiographic Outcomes for Posterior Fossa Decompression with and without Duraplasty for Treatment of Pediatric Chiari I Malformation: A Prospective Study. AU - Jiang,Enze, AU - Sha,Shifu, AU - Yuan,XinXin, AU - Zhu,WeiGuo, AU - Jiang,Jian, AU - Ni,Hongbin, AU - Liu,Zhen, AU - Qiu,Yong, AU - Zhu,Zezhang, Y1 - 2017/11/10/ PY - 2017/07/20/received PY - 2017/11/01/revised PY - 2017/11/03/accepted PY - 2017/11/15/pubmed PY - 2018/5/17/medline PY - 2017/11/15/entrez KW - Chiari malformation type I KW - Clinical outcome KW - Duraplasty KW - Posterior fossa decompression KW - Syringomyelia KW - Tonsillar herniation SP - e465 EP - e472 JF - World neurosurgery JO - World Neurosurg VL - 110 N2 - OBJECTIVE: The aim of this study was to prospectively compare the radiographic and clinical outcomes between the posterior fossa decompression (PFD) and PFD with duraplasty (PFDD) procedures in adolescent patients with Chiari malformation type I (CMI). METHODS: Ninety adolescent patients with CMI were randomly assigned to undergo either PFDD or PFD. In both groups, a dissection from the occipital bone was performed. The dura was not opened in the PFD group, and the outer layer of dura was resected. However, in the PFDD group, the dura mater was opened and expanded. Data were analyzed for clinical outcome, complications, and syrinx resolution. RESULTS: The age, gender, and preoperative neurologic status were similar between the 2 groups. Compared with the PFD group, patients undergoing PFDD had significantly longer operation time, longer postoperative drainage time, and higher drainage volume. At the latest follow-up, no statistically significant difference was found between the 2 groups in terms of syrinx resolution. The clinical outcomes were similar in the PFDD and PFD group. Compared with the PFD group, patients in the PFDD group had a higher incidence of cerebrospinal fluid leak. CONCLUSIONS: Compared with the more aggressive decompression with duraplasty, PFD without duraplasty produces comparable radiologic and clinical outcomes and is associated with a lower risk of complications. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29133007/Comparison_of_Clinical_and_Radiographic_Outcomes_for_Posterior_Fossa_Decompression_with_and_without_Duraplasty_for_Treatment_of_Pediatric_Chiari_I_Malformation:_A_Prospective_Study_ DB - PRIME DP - Unbound Medicine ER -