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Outcomes of Dura Splitting Decompression Versus Posterior Fossa Decompression With Duraplasty in the Treatment of Chiari I Malformation: A Systematic Review and Meta-analysis.
World Neurosurg. 2021 03; 147:105-114.WN

Abstract

BACKGROUND

Surgery is the definitive treatment option for symptomatic Chiari malformation I (CMI), but there is no clear consensus as to the preferred surgical method. This study aimed to quantitatively assess and compare the effect and safety of dura splitting decompression (DSD) and posterior fossa decompression with duraplasty (PFDD) in treating patients with CMI.

METHODS

A literature search of EMBASE, MEDLINE, PubMed, Cochrane Library, and Web of Science databases was conducted. References from January 1990 to September 2020 were retrieved. We only included papers containing original data, comparing the use of DSD and PFDD in CMI patients.

RESULTS

Overall, 11 relevant studies were identified, wherein 443 patients treated for CMI by DSD were compared with 261 patients treated by PFDD. No difference was observed between PFDD and PFD in terms of clinical improvement (P = 0.69), syringomyelia improvement (P = 0.90), or reoperation (P = 0.22). DSD was associated with shorter operation durations (P = 0.0007), shorter length of stay (P = 0.0007), and shorter overall postoperative complications (P < 0.0001) (especially cerebrospinal fluid [CSF] leak [P = 0.005], meningitis [P = 0.002], and pseudomeningocele [P = 0.002]), as compared with PFDD.

CONCLUSIONS

This study confirmed that dura splitting decompression has clinical and syringomyelia improvement outcomes comparable to posterior fossa decompression with duraplasty. Compared with PFDD, DSD not only significantly shortened the operation time and length of stay, but also significantly reduced the overall complication rate, especially those related to incidence of CSF-related complications. More evidence from advanced multicenter studies are needed to require to validate the findings.

Authors+Show Affiliations

Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, People's Republic of China.Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, People's Republic of China.Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, People's Republic of China.Department of Imaging, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, People's Republic of China.Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, People's Republic of China.Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, People's Republic of China. Electronic address: xjsjwk@163.com.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33290896

Citation

Chang, Teng-Wu, et al. "Outcomes of Dura Splitting Decompression Versus Posterior Fossa Decompression With Duraplasty in the Treatment of Chiari I Malformation: a Systematic Review and Meta-analysis." World Neurosurgery, vol. 147, 2021, pp. 105-114.
Chang TW, Zhang X, Maoliti W, et al. Outcomes of Dura Splitting Decompression Versus Posterior Fossa Decompression With Duraplasty in the Treatment of Chiari I Malformation: A Systematic Review and Meta-analysis. World Neurosurg. 2021;147:105-114.
Chang, T. W., Zhang, X., Maoliti, W., Yuan, Q., Yang, X. P., & Wang, J. C. (2021). Outcomes of Dura Splitting Decompression Versus Posterior Fossa Decompression With Duraplasty in the Treatment of Chiari I Malformation: A Systematic Review and Meta-analysis. World Neurosurgery, 147, 105-114. https://doi.org/10.1016/j.wneu.2020.11.163
Chang TW, et al. Outcomes of Dura Splitting Decompression Versus Posterior Fossa Decompression With Duraplasty in the Treatment of Chiari I Malformation: a Systematic Review and Meta-analysis. World Neurosurg. 2021;147:105-114. PubMed PMID: 33290896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Dura Splitting Decompression Versus Posterior Fossa Decompression With Duraplasty in the Treatment of Chiari I Malformation: A Systematic Review and Meta-analysis. AU - Chang,Teng-Wu, AU - Zhang,Xv, AU - Maoliti,Wulabeike, AU - Yuan,Qv, AU - Yang,Xiao-Peng, AU - Wang,Ji-Chao, Y1 - 2020/12/05/ PY - 2020/10/21/received PY - 2020/11/29/accepted PY - 2020/12/9/pubmed PY - 2021/7/6/medline PY - 2020/12/8/entrez KW - Chiari malformation I KW - Dura splitting decompression KW - Duraplasty KW - Meta-analysis KW - Posterior fossa decompression KW - Systematic review SP - 105 EP - 114 JF - World neurosurgery JO - World Neurosurg VL - 147 N2 - BACKGROUND: Surgery is the definitive treatment option for symptomatic Chiari malformation I (CMI), but there is no clear consensus as to the preferred surgical method. This study aimed to quantitatively assess and compare the effect and safety of dura splitting decompression (DSD) and posterior fossa decompression with duraplasty (PFDD) in treating patients with CMI. METHODS: A literature search of EMBASE, MEDLINE, PubMed, Cochrane Library, and Web of Science databases was conducted. References from January 1990 to September 2020 were retrieved. We only included papers containing original data, comparing the use of DSD and PFDD in CMI patients. RESULTS: Overall, 11 relevant studies were identified, wherein 443 patients treated for CMI by DSD were compared with 261 patients treated by PFDD. No difference was observed between PFDD and PFD in terms of clinical improvement (P = 0.69), syringomyelia improvement (P = 0.90), or reoperation (P = 0.22). DSD was associated with shorter operation durations (P = 0.0007), shorter length of stay (P = 0.0007), and shorter overall postoperative complications (P < 0.0001) (especially cerebrospinal fluid [CSF] leak [P = 0.005], meningitis [P = 0.002], and pseudomeningocele [P = 0.002]), as compared with PFDD. CONCLUSIONS: This study confirmed that dura splitting decompression has clinical and syringomyelia improvement outcomes comparable to posterior fossa decompression with duraplasty. Compared with PFDD, DSD not only significantly shortened the operation time and length of stay, but also significantly reduced the overall complication rate, especially those related to incidence of CSF-related complications. More evidence from advanced multicenter studies are needed to require to validate the findings. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/33290896/Outcomes_of_Dura_Splitting_Decompression_Versus_Posterior_Fossa_Decompression_With_Duraplasty_in_the_Treatment_of_Chiari_I_Malformation:_A_Systematic_Review_and_Meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(20)32548-1 DB - PRIME DP - Unbound Medicine ER -