SURGICAL OUTCOME AFTER DURA-SPLITTING DECOMPRESSION IN CHIARI MALFORMATION І

Document Type : Original Articles

Authors

1 Lecturer of Neurosurgery Neurosurgery Department Alexandria Universtity

2 Neurosurgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

3 Department of Neurosurgery, Alexandria University School of Medicine, EGYPT

Abstract

Background Treating Chiari malformation I (CM I), most surgeons practice a suboccipital craniectomy with duroplasty. However, duroplasty could impose several operative hazards ranging from hypotensive headache up to fatal meningitis. Dural splitting decompression, can achieve comparable clinical outcome, yet with higher safety profile.
Aim To analyze the clinical and radiological outcome following dural splitting decompression in Chiari malformation I patients, compared to standard duroplasty.
Materials and Methods Retrospective analysis of 84 patients with CM I who had surgery at Alexandria Neurosurgery Department between January 2015, and August 2021. Patients were divided into two groups following bony decompression; the first group had splitting of outer dura, whereas the second group had duroplasty. Data collected included patients’ demographic data, preoperative and postoperative clinical, and radiological outcome were tabulated and analyzed.
Results 84 patients with CM I underwent suboccipital craniectomy. 40 patients underwent duroplasty and 44 patients had dural splitting. Mean age at presentation was 38.5 years (dural splitting) and 36.6 years (duroplasty).This study included 59 females and 25 males. Mean follow up period was 17.2 months . Both techniques achieved comparable clinical outcome. Dural splitting decompression achieved less blood loss, and hospital stay. Dural splitting technique had statistically significant less postoperative complications, and less operative time. There was no statistically significant difference as regard clinical improvement, or improvement of syringomyelia.
Conclusion Dural splitting provides respectable clinical and radiological improvement in CM I patients compared to duroplasty, meanwhile with more safety, less operative time, less need for blood transfusion and shorter hospital stay.

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