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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 423-436
DOI: 10.1055/s-0043-1764324
Review Article

Clinical and Radiological Outcomes of Dura-Splitting versus Duraplasty Techniques in Pediatric Chiari I Malformation: A Systematic Review and Meta-Analysis

Amin Tavallaii 
1   Department of Neurosurgery, Akbar Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
,
Ehsan Keykhosravi 
2   Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
,
Ahmad Ghorbanpour 
2   Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
,
Ali Shahriari 
3   Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran
,
Hamid Rezaee 
2   Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract

Type I Chiari malformation is a developmental anomaly with various proposed surgical techniques for its management. The dura-splitting technique is a less invasive approach and involves the resection of the outer layer of the dura while sparing the internal layer. While this less-known approach may minimize the complication rates, there are concerns about its efficacy and outcome. Therefore, we have performed a systematic review and meta-analysis of available data on clinical and radiological outcomes of this technique in the pediatric population and compared them to the foramen magnum decompression and duraplasty technique.

We have followed the Meta-analysis Of Observational Studies in Epidemiology guidelines in this review. Based on our predefined search strategy, we performed a systematic database search. Subsequently, the article screening process was done based on defined inclusion/exclusion criteria. Following the quality assessment of included studies, two authors performed data extraction. Finally, the extracted data were summarized and presented in form of tables. Forest plots were used to demonstrate the results of the meta-analysis.

A review of 8 included studies consisting of 615 patients revealed the significant advantage of the dura-splitting technique in terms of shorter operation duration and hospital stay. The recurrence rate and clinical and radiological outcomes were almost similar between the two surgical techniques. Complication rates were significantly lower in the dura-splitting technique.

Dura-splitting can be an effective and safe approach for the management of pediatric Chiari I malformation. However, these results are mostly extracted from observational studies and future randomized controlled trials are recommended.

Keywords

Chiari malformation type I - dura-splitting - duraplasty - outcome - pediatric

Authors' Contributions

Amin Tavallaii conceptualized the study. Amin Tavallaii, Ehsan Keykhosravi, and Ahmad Ghorbanpour were involved in article screening. Amin Tavallaii, Ahmad Ghorbanpour, and Ali Shahriari helped in data extraction. Amin Tavallaii, Ehsan Keykhosravi, and Hamid Rezaee helped in analysis. Amin Tavallaii and Hamid Rezaee drafted the work. All authors provided final approval.


Supplementary Material



Publication History

Article published online:
01 May 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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