Subscribe to RSS
Clinical and Radiological Outcomes of Dura-Splitting versus Duraplasty Techniques in Pediatric Chiari I Malformation: A Systematic Review and Meta-Analysis
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.
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.
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/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Caldarelli M, Novegno F, Vassimi L, Romani R, Tamburrini G, Di Rocco C. The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation Type I: experience with a pediatric series. J Neurosurg 2007; 106 (3, Suppl): 187-195
- 2 Heiss JD, Patronas N, DeVroom HL. et al. Elucidating the pathophysiology of syringomyelia. J Neurosurg 1999; 91 (04) 553-562
- 3 Tavallaii A, Keykhosravi E, Rezaee H, Abouei Mehrizi MA, Ghorbanpour A, Shahriari A. Outcomes of dura-splitting technique compared to conventional duraplasty technique in the treatment of adult Chiari I malformation: a systematic review and meta-analysis. Neurosurg Rev 2021; 44: 1313-1329 DOI: 10.1007/s10143-020-01334-y.
- 4 Tavallaii A, Keykhosravi E. Clinical and radiologic outcomes of dura-splitting technique versus other surgical techniques in pediatric Chiari I malformation: a systematic review and meta-analysis. 2019; Accessed February 18, 2023 at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019134781 2019
- 5 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283 (15) 2008-2012
- 6 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
- 7 DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials 2015; 45 (Pt A): 139-145
- 8 Limonadi FM, Selden NR. Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. J Neurosurg 2004; 101 (2, Suppl): 184-188
- 9 Navarro R, Olavarria G, Seshadri R, Gonzales-Portillo G, McLone DG, Tomita T. Surgical results of posterior fossa decompression for patients with Chiari I malformation. Childs Nerv Syst 2004; 20 (05) 349-356
- 10 Galarza M, Sood S, Ham S. Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Childs Nerv Syst 2007; 23 (06) 691-696
- 11 Litvack ZN, Lindsay RA, Selden NR. Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization. Neurosurgery 2013; 72 (06) 922-928 , discussion 928–929
- 12 Pomeraniec IJ, Ksendzovsky A, Awad AJ, Fezeu F, Jane Jr JA. Natural and surgical history of Chiari malformation type I in the pediatric population. J Neurosurg Pediatr 2016; 17 (03) 343-352
- 13 Grahovac G, Pundy T, Tomita T. Chiari type I malformation of infants and toddlers. Childs Nerv Syst 2018; 34 (06) 1169-1176
- 14 Pisapia JM, Merkow MB, Brewington D. et al. External validity of the Chiari severity index and outcomes among pediatric Chiari I patients treated with intra- or extra-Dural decompression. Childs Nerv Syst 2017; 33 (02) 313-320
- 15 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
- 16 Massimi L, Frassanito P, Bianchi F, Tamburrini G, Caldarelli M. Bony decompression vs duraplasty for Chiari I malformation: does the eternal dilemma matter?. Childs Nerv Syst 2019; 35 (10) 1827-1838
- 17 Alexander H, Tsering D, Myseros JS. et al. Management of Chiari I malformations: a paradigm in evolution. Childs Nerv Syst 2019; 35 (10) 1809-1826
- 18 Lin W, Duan G, Xie J, Shao J, Wang Z, Jiao B. Comparison of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I: a systematic review and meta-analysis. World Neurosurg 2018; 110: 460-474.e5
- 19 Chai Z, Xue X, Fan H. et al. Efficacy of posterior fossa decompression with duraplasty for patients with Chiari malformation type I: a systematic review and meta-analysis. World Neurosurg 2018; 113: 357-365.e1
- 20 Xu H, Chu L, He R, Ge C, Lei T. Posterior fossa decompression with and without duraplasty for the treatment of Chiari malformation type I-a systematic review and meta-analysis. Neurosurg Rev 2017; 40 (02) 213-221
- 21 Lu VM, Phan K, Crowley SP, Daniels DJ. The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: a systematic review and meta-analysis of surgical and performance outcomes. J Neurosurg Pediatr 2017; 20 (05) 439-449
- 22 Zhao JL, Li MH, Wang CL, Meng W. A systematic review of Chiari I malformation: techniques and outcomes. World Neurosurg 2016; 88: 7-14
- 23 Gardner WJ. Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry 1965; 28 (03) 247-259
- 24 Williams B. The distending force in the production of communicating syringomyelia. Lancet 1969; 2 (7622): 696
- 25 Chauvet D, Carpentier A, Allain JM, Polivka M, Crépin J, George B. Histological and biomechanical study of dura mater applied to the technique of dura splitting decompression in Chiari type I malformation. Neurosurg Rev 2010; 33 (03) 287-294 , discussion 295
- 26 Brock RS, Taricco MA, de Oliveira MF, de Lima Oliveira M, Teixeira MJ, Bor-Seng-Shu E. Intraoperative ultrasonography for definition of less invasive surgical technique in patients with Chiari type i malformation. World Neurosurg 2017; 101: 466-475
- 27 Klekamp J. Surgical treatment of Chiari I malformation–analysis of intraoperative findings, complications, and outcome for 371 foramen magnum decompressions. Neurosurgery 2012; 71 (02) 365-380 , discussion 380
- 28 Kotil K, Ton T, Tari R, Savas Y. Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study. Cerebrospinal Fluid Res 2009; 6: 7
- 29 Perrini P, Anania Y, Cagnazzo F, Benedetto N, Morganti R, Di Carlo DT. Radiological outcome after surgical treatment of syringomyelia-Chiari I complex in adults: a systematic review and meta-analysis. Neurosurg Rev 2020; 177-187