Skip to main content
SpringerLink
Log in

Comparison of surgical outcomes in patients with Chiari Type I malformation receiving posterior fossa decompression with and without duraplasty

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The goals of this study were to compare clinical outcomes in patients with Chiari Malformation Type I (CMI) receiving posterior fossa decompression with (PFDD) or without duraplasty (PFD).

Methods

We conducted a retrospective analysis of 178 consecutive cases of 157 patients undergoing PFDD or PFD for CMI at Cohen Children’s Medical Center between 2007 and 2017. Clinical improvement was defined as a clear reduction of preoperative symptoms after surgery as reported by patients and parents. An improvement of syrinx was derived from radiologic comparison of pre- and postoperative MR imaging. Chi-square analysis was performed to analyze the association between duraplasty and clinical parameters (alpha = 0.05).

Results

The primary presenting complaint was headache (142/178; 80%), followed by neck, back, and upper extremity pain, and numbness or tingling (49/178; 28%). Seventy patients (78/178; 44%) underwent PFD, and 100 patients (100/178; 56%) underwent PFDD. Overall, 143 patients (143/178; 80%) experienced subjective improvement with no statistically significant difference between the two surgical techniques (p = 0.705). The number of patients receiving PFDD with syrinx improvement or stabilization (55/59; 93%) was statistically larger than those that received PFD (8/13; 62%) (p = 0.008). PFDD was associated with greater complications than PFD alone. There were 35 cases of reoperation overall (35/178; 19%), and there was no statistically significant difference in reoperation rate between PFD and PFDD (p = 0.255).

Conclusions

There appears to be a role for PFDD in patients with severe syringomyelia, but overall, PFD alone may be safely offered as the initial surgical intervention for symptomatic CMI patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, Speer MC (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 44:1005–1017. https://doi.org/10.1097/00006123-199905000-00042

    Article  CAS  PubMed  Google Scholar 

  2. Massimi L, Caldarelli M, Frassanito P, Di Rocco C (2011) Natural history of Chiari type I malformation in children. Neurol Sci 32:275–277. https://doi.org/10.1007/s10072-011-0684-3

    Article  Google Scholar 

  3. Aitken LA, Lindan CE, Sidney S, Gupta N, Barkovich AJ, Sorel M, Wu YW (2009) Chiari Type I malformation in a pediatric population. Pediatr Neurol 40:449–454. https://doi.org/10.1016/j.pediatrneurol.2009.01.003

    Article  PubMed  PubMed Central  Google Scholar 

  4. Alzate JC, Kothbauer KF, Jallo GI, Epstein FJ (2001) Treatment of Chiari I malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus 11:1–9. https://doi.org/10.3171/foc.2001.11.1.4

    Article  Google Scholar 

  5. Anderson NE, Willoughby EW, Wrightson P (1985) The natural history and the influence of surgical treatment in syringomyelia. Acta Neurol Scand 71:472–479. https://doi.org/10.1111/j.1600-0404.1985.tb03230.x

    Article  CAS  PubMed  Google Scholar 

  6. Galarza M, Sood S, Ham S (2007) Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Childs Nerv Syst 23:691–696. https://doi.org/10.1007/s00381-007-0297-6

    Article  PubMed  Google Scholar 

  7. Alden TD, Ojemann JG, Park TS (2001) Surgical treatment of Chiari I malformation: indications and approaches. Neurosurg, Focus

    Google Scholar 

  8. Attenello FJ, McGirt MJ, Garcés-Ambrossi GL et al (2009) Suboccipital decompression for Chiari I malformation: outcome comparison of duraplasty with expanded polytetrafluoroethylene dural substitute versus pericranial autograft. Childs Nerv Syst 25:183–190. https://doi.org/10.1007/s00381-008-0700-y

    Article  PubMed  Google Scholar 

  9. Fischer EG (1995) Posterior fossa decompression for Chiari I deformity, including resection of the cerebellar tonsils. Childs Nerv Syst 11:625–629. https://doi.org/10.1007/BF00300718

    Article  CAS  PubMed  Google Scholar 

  10. Krieger MD, McComb JG, Levy ML (1999) Toward a simpler surgical management of Chiari I malformation in a pediatric population. Pediatr Neurosurg 30:113–121. https://doi.org/10.1159/000028777

    Article  CAS  PubMed  Google Scholar 

  11. Navarro R, Olavarria G, Seshadri R, Gonzales-Portillo G, McLone DG, Tomita T (2004) Surgical results of posterior fossa decompression for patients with Chiari I malformation. Childs Nerv Syst 20:349–356. https://doi.org/10.1007/s00381-003-0883-1

    Article  PubMed  Google Scholar 

  12. Limonadi FM, Selden NR (2004) Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. J Neurosurg 101:184–188. https://doi.org/10.3171/ped.2004.101.2.0184

    Article  PubMed  Google Scholar 

  13. Litvack ZN, Lindsay RA, Selden NR (2013) Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization. Neurosurgery. 72:922–929. https://doi.org/10.1227/NEU.0b013e31828ca1ed

    Article  PubMed  Google Scholar 

  14. Mutchnick IS, Janjua RM, Moeller K, Moriarty TM (2010) Decompression of Chiari malformation with and without duraplasty: morbidity versus recurrence. J Neurosurg Pediatr 5:474–478. https://doi.org/10.3171/2010.1.PEDS09218

    Article  PubMed  Google Scholar 

  15. Foreman P, Safavi-A Bbasi S, Talley MC et al (2012) Perioperative outcomes and complications associated with allogeneic duraplasty for the management of Chiari malformations Type i in 48 pediatric patients: Clinical article. J Neurosurg Pediatr 10:142–149. https://doi.org/10.3171/2012.5.PEDS11406

    Article  PubMed  Google Scholar 

  16. Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD (2014) Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation. Childs Nerv Syst 30:1419–1424. https://doi.org/10.1007/s00381-014-2424-5

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kennedy BC, Nelp TB, Kelly KM, Phan MQ, Bruce SS, McDowell MM, Feldstein NA, Anderson RCE (2015) Delayed resolution of syrinx after posterior fossa decompression without dural opening in children with Chiari malformation Type i. J Neurosurg Pediatr 16:599–606. https://doi.org/10.3171/2015.4.PEDS1572

    Article  PubMed  Google Scholar 

  18. Xu H, Chu LY, He R, Ge C, Lei T (2017) Posterior fossa decompression with and without duraplasty for the treatment of Chiari malformation type I—a systematic review and meta-analysis. Neurosurg Rev 40:213–221

    Article  Google Scholar 

  19. de Oliveira SU, de Oliveira MF, Heringer LC et al (2018) The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis. Neurosurg Rev 41:311–321. https://doi.org/10.1007/s10143-017-0857-5

    Article  PubMed  Google Scholar 

  20. Lu VM, Phan K, Crowley SP, Daniels DJ (2017) 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

    Google Scholar 

  21. Schady W, Metcalfe RA, Butler P (1987) The incidence of craniocervical bony anomalies in the adult Chiari malformation. J Neurol Sci 82:193–203. https://doi.org/10.1016/0022-510X(87)90018-9

    Article  CAS  PubMed  Google Scholar 

  22. Trigylidas T, Baronia B, Vassilyadi M, Ventureyra ECG (2008) Posterior fossa dimension and volume estimates in pediatric patients with Chiari I malformations. Childs Nerv Syst 24:329–336. https://doi.org/10.1007/s00381-007-0432-4

    Article  CAS  PubMed  Google Scholar 

  23. Tubbs RS, Beckman J, Naftel RP, Chern JJ, Wellons JC, Rozzelle CJ, Blount JP, Oakes WJ (2011) Institutional experience with 500 cases of surgically treated pediatric Chiari malformation type I. J Neurosurg Pediatr 7:248–256. https://doi.org/10.3171/2010.12.PEDS10379

    Article  PubMed  Google Scholar 

  24. Hankinson T, Tubbs RS, Wellons JC (2011) Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation. In: Duraplasty or not? An evidence-based review of the pediatric Chiari i malformation. Child’s Nerv, Syst

    Chapter  Google Scholar 

  25. Durham SR, Fjeld-Olenec K (2008) 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 2:42–49. https://doi.org/10.3171/PED/2008/2/7/042

    Article  PubMed  Google Scholar 

  26. Caldarelli M, Novegno F, Massimi L, Romani R, Tamburrini G, di Rocco C (2007) The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation Type I: Experience with a pediatric series. J Neurosurg 106:187–195. https://doi.org/10.3171/ped.2007.106.3.187

    Article  PubMed  Google Scholar 

  27. Chauvet D, Carpentier A, George B (2009) Dura splitting decompression in Chiari type 1 malformation: clinical experience and radiological findings. Neurosurg Rev 32:465–470. https://doi.org/10.1007/s10143-009-0214-4

    Article  PubMed  Google Scholar 

  28. Rocque BG, George TM, Kestle J, Iskandar BJ (2011) Treatment practices for Chiari malformation Type I with syringomyelia: results of a survey of the American Society of Pediatric Neurosurgeons: clinical article. J Neurosurg Pediatr 8:430–437. https://doi.org/10.3171/2011.8.PEDS10427

    Article  PubMed  Google Scholar 

  29. Singhal A, Cheong A, Steinbok P (2018) International survey on the management of Chiari 1 malformation and syringomyelia: evolving worldwide opinions. Childs Nerv Syst 34:1177–1182. https://doi.org/10.1007/s00381-018-3741-x

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA

    Samuel Butensky, Shaun Rodgers, Steven Schneider & Mark Mittler

  2. Division of Pediatric Neurosurgery, Cohen Children’s Medical Center of New York, New Hyde Park, NY, 11040, USA

    Shaun Rodgers, Shanna Baron, Steven Schneider & Mark Mittler

Authors
  1. Samuel Butensky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shaun Rodgers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shanna Baron
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Mittler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shaun Rodgers.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Butensky, S., Rodgers, S., Baron, S. et al. Comparison of surgical outcomes in patients with Chiari Type I malformation receiving posterior fossa decompression with and without duraplasty. Childs Nerv Syst 36, 1399–1405 (2020). https://doi.org/10.1007/s00381-020-04667-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-020-04667-7

Keywords

Search

Navigation