Download PDF
J Neurol Surg A Cent Eur Neurosurg 2023; 84(04): 370-376
DOI: 10.1055/a-1877-0074
Original Article

Comparison of Clinical and Radiologic Outcomes between Dural Splitting and Duraplasty for Adult Patients with Chiari Type I Malformation

Muhammet Arif Özbek 
1   Department of Neurosurgery, Istanbul Medipol University, Istanbul, İstanbul, Turkey
,
Ahmet Tulgar Başak
2   Department of Neurosurgery, American Hospital, Istanbul, Turkey
,
Nazlı Çakıcı
3   Department of Neurosurgery, Medicana Health Group, Istanbul, Turkey
,
Sevket Evran
4   Neurosurgery Clinic, Haseki Training and Research Hospital, Istanbul, Turkey
,
Ahmet Kayhan
4   Neurosurgery Clinic, Haseki Training and Research Hospital, Istanbul, Turkey
,
Tahsin Saygı
4   Neurosurgery Clinic, Haseki Training and Research Hospital, Istanbul, Turkey
,
Oguz Baran
5   Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background The most used surgical procedure in the treatment of patients with Chiari type I malformation (CIM) is posterior fossa decompression. However, no consensus has been reached regarding the superiority of either dural splitting or duraplasty. Thus, the aim of this study was to compare clinical and radiologic outcomes between the two techniques used in consecutive patients.

Methods We retrospectively reviewed 74 adult patients with CIM who were diagnosed and treated surgically between 2015 and 2020 at our neurosurgery department. The patients were divided into two groups: dural splitting in group 1 and duraplasty in group 2. Clinical outcomes based on Chicago Chiari Outcome Scale (CCOS) scores at the last control visits were compared between the groups. Radiologic outcomes were compared in terms of tonsillar regression rate based on 12-postoperative-month magnetic resonance images.

Results Overall improved, unchanged, and worsened neurologic statuses were observed in 75.6% (n = 56), 17.5% (n = 13), and 6.7% (n = 5) of our patients, respectively. The mean last visit CCOS scores in groups 1 and 2 were 12.3 ± 2.1 and 13.5 ± 1.7, respectively. The difference between the groups was statistically significant (p < 0.01). The mean tonsillar regression rates were 34.7 ± 17.0% and 52.1 ± 15.3% in groups 1 and 2, respectively, with a statistically significant difference (p < 0.001).

Conclusion Adult patients undergoing duraplasty had better clinical and radiologic outcomes than those treated with dural splitting. Therefore, we recommend decompression with duraplasty for adult CIM patients.

Keywords

Chiari type I malformation - duraplasty - dural splitting - clinical improvement - radiologic regression


Publication History

Received: 14 July 2021

Accepted: 13 June 2022

Accepted Manuscript online:
15 June 2022

Article published online:
20 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Papaker MG, Abdallah A, Cesme DH. et al. Clinical and radiological evaluation of treated Chiari I adult patients: retrospective study from two neurosurgical centers. Neurosurg Rev 2021; 44 (04) 2261-2276
    CrossrefPubMedGoogle Scholar
  • 2 Aliaga L, Hekman KE, Yassari R. et al. A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery 2012; 70 (03) 656-664 , discussion 664–665
    CrossrefPubMedGoogle Scholar
  • 3 Sahuquillo J, Rubio E, Poca M-A, Rovira A, Rodriguez-Baeza A, Cervera C. Posterior fossa reconstruction: a surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex: preliminary results and magnetic resonance imaging quantitative assessment of hindbrain migration. Neurosurgery 1994; 35 (05) 874-884 , discussion 884–885
    CrossrefPubMedGoogle Scholar
  • 4 Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ. The pediatric Chiari I malformation: a review. Childs Nerv Syst 2007; 23 (11) 1239-1250
    CrossrefPubMedGoogle Scholar
  • 5 Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Chiari malformation type I and syrinx in children undergoing magnetic resonance imaging. J Neurosurg Pediatr 2011; 8 (02) 205-213
    CrossrefPubMedGoogle Scholar
  • 6 Novegno F, Caldarelli M, Massa A. et al. The natural history of the Chiari type I anomaly. J Neurosurg Pediatr 2008; 2 (03) 179-187
    CrossrefPubMedGoogle Scholar
  • 7 Pandey S, Li L, Wan RH, Gao L, Xu W, Cui DM. A retrospective study on outcomes following posterior fossa decompression with dural splitting surgery in patients with Chiari type I malformation. Clin Neurol Neurosurg 2020; 196: 106035
    CrossrefPubMedGoogle Scholar
  • 8 Abdallah A, Emel E, Gündüz HB, Sofuoğlu ÖE, Asiltürk M, Abdallah BG. Long-term surgical resection outcomes of pediatric myxopapillary ependymoma: experience of two centers and brief literature review. World Neurosurg 2020; 136: e245-e261
    CrossrefPubMedGoogle Scholar
  • 9 Abdallah A, Emel E, Abdallah BG, Asiltürk M, Sofuoğlu ÖE. Factors affecting the surgical outcomes of tethered cord syndrome in adults: a retrospective study. Neurosurg Rev 2018; 41 (01) 229-239
    CrossrefPubMedGoogle Scholar
  • 10 McGirt MJ, Attenello FJ, Atiba A. et al. Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases. Childs Nerv Syst 2008; 24 (11) 1333-1339
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 Alzate JC, Kothbauer KF, Jallo GI, Epstein FJ. Treatment of Chiari I malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus 2001; 11 (01) E3
    CrossrefPubMedGoogle Scholar
  • 13 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, e5
    CrossrefPubMedGoogle Scholar
  • 14 Aslan A, Rakip U, Boyacı MG. et al. Posterior fossa decompression and superficial durotomy rather than complete durotomy and duraplasty in the management of Chiari 1. Neurol Res 2021; 43 (06) 440-446
    CrossrefPubMedGoogle Scholar
  • 15 Durham SR, Fjeld-Olenec K. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in pediatric patients: a meta-analysis. J Neurosurg Pediatr 2008; 2 (01) 42-49
    CrossrefPubMedGoogle Scholar
  • 16 Ciappetta P, Signorelli F, Visocchi M. The role of arachnoid veils in Chiari malformation associated with syringomyelia. In: New Trends in Craniovertebral Junction Surgery. Springer; 2019: 97-99
    Google Scholar
  • 17 Gardner WJ, Angel J. The mechanism of syringomyelia and its surgical correction. Clin Neurosurg. 1958; 6: 131-140 DOI: 10.1093/neurosurgery/6.cn_suppl_1.131.
    CrossrefPubMedGoogle Scholar
  • 18 Erdogan E, Cansever T, Secer HI. et al. The evaluation of surgical treatment options in the Chiari Malformation Type I. Turk Neurosurg 2010; 20 (03) 303-313 DOI: 10.5137/1019-5149.JTN.2648-09.2.
    CrossrefPubMedGoogle Scholar
  • 19 Kumar A, Pruthi N, Devi BI, Gupta AK. Functional outcome for Chiari malformation using a novel scoring system. Indian Journal of Neurosurgery 2018; 7 (03) 179-183
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Romero FR, Pereira CAde B. Suboccipital craniectomy with or without duraplasty: what is the best choice in patients with Chiari type 1 malformation?. Arquivos de neuro-psiquiatria 2010; 68 (04) 623-626
    CrossrefPubMedGoogle Scholar
  • 21 Dyste GN, Menezes AH, VanGilder JC. Symptomatic Chiari malformations: an analysis of presentation, management, and long-term outcome. Journal of neurosurgery 1989; 71 (02) 159-168
    CrossrefPubMedGoogle Scholar