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Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation

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Abstract

Purpose

Chiari malformation type I (CM1) is a common and often debilitating neurosurgical disease. Whether to treat CM1 patients with a traditional posterior fossa decompression with duraplasty (PFDD) or a less invasive extradural decompression (PFDO) is controversial. The purpose of this study was to compare clinical outcome and syrinx resolution between the two procedures.

Methods

We retrospectively reviewed the records of 36 patients treated with PFDD and 29 patients with PFDO between 2003 and 2011. We compared baseline demographic, clinical, and radiographic characteristics. The primary clinical outcome was the Chicago Chiari Outcome Scale (CCOS). The primary radiographic outcome was qualitative syrinx improvement or resolution.

Results

At baseline, age and sex distributions, radiographic characteristics, and presenting symptoms were similar in patients undergoing PFDD and PFDO. Patients undergoing PFDO had shorter surgical time (1.5 vs. 2.8 h; p < 0.001) and length of hospital stay (2.1 days compared to 3.3 days; p < 0.001). Cerebrospinal fluid-related complications were more common in patients receiving PFDD (7/36) than PFDO (0/29) (p = 0.014). Clinical improvement, defined by the mean CCOS score, was comparable in patients receiving PFDO (14.7) and PFDD (14.6) (p = 0.70). Among patients with postoperative syrinx imaging, 10/13 in the PFDD group improved or resolved, compared to 8/8 in the PFDO group (p = 0.26).

Conclusions

Extradural decompression for CM1 produces comparable rates of clinical and radiographic improvement as the more invasive decompression with duraplasty. Given the increased morbidity and resource utilization associated with PFDD, PFDO should be considered an attractive first-line option for most CM1 patients.

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Ethical standards

The Washington University in St. Louis Institutional Review Board approved this study, and it was conducted in accordance with the Declaration of Helsinki and its later amendments. The Institutional Review Board waived the need for informed consent.

Funding

This work was supported by the Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and TL1 TR000449 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA

    Amy Lee

  2. Department of Neurosurgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, USA

    Chester K. Yarbrough, Jacob K. Greenberg, David D. Limbrick & Matthew D. Smyth

  3. Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA, USA

    Jason Barber

Authors
  1. Amy Lee
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  2. Chester K. Yarbrough
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  3. Jacob K. Greenberg
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  4. Jason Barber
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  5. David D. Limbrick
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  6. Matthew D. Smyth
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Corresponding author

Correspondence to Amy Lee.

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Lee, A., Yarbrough, C.K., Greenberg, J.K. et al. Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation. Childs Nerv Syst 30, 1419–1424 (2014). https://doi.org/10.1007/s00381-014-2424-5

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  • DOI: https://doi.org/10.1007/s00381-014-2424-5

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