Dural splitting has similar therapeutic efficacy with less complications, shorter operative and hospitalization times when compared to duraplasty in chiari type-I malformation

Abstract

Background: A standard surgical technique has not been developed for Chiari Type-1 malformation. Recently, dural-splitting has also been introduced in addition to duraplasty. We aimed to determine both surgical techniques’ advantages/disadvantages clinically and radiologically.
 Material and Method: We retrospectively evaluated 28 patients’ data with Chiari Type-I malformation and operated at the Neurosurgery Department of Bülent Ecevit University between January 2014 and April 2018. We retrieved demographic characteristics, symptoms, physical/neurological findings, preoperative/postoperative imaging data/measurements, VAS, Chicago Chiari Outcome Scale, Neck Disability Index, Neurological Scoring System, and modified-JOA scores, operation and hospitalization times, and complications from the automation system.
 Results: Patients’ mean age was 38.5±13.0 years, and female/male ratio was 2.1/1. Syringomyelia was present in half of all cases. Mean tonsil herniation length was 11.64±4 mm, and mean tonsillo-dural distance was 4.18±1.7 mm. There were no significant relationships between tonsil herniation length and syringomyelia, and between tonsillo-dural distance and clinical improvement. Posterior fossa decompression was initially performed in all patients. Then, in 17 patients, duraplasty was performed. In 11 patients, dural-splitting was used. No significant differences were determined between duraplasty and dural-splitting regarding VAS, Chicago Chiari Outcome Scale, Neck Disability Index, Neurological Scoring System, and modified-JOA scores. Significant differences were present, favoring dural-splitting regarding operation time, hospital stay, and complication rates.
 Conclusion: Posterior fossa decompression/duraplasty is an effective surgical technique to treat Chiari Type-I malformation. Posterior fossa decompression/dural-splitting is an optimal surgical alternative with a lower complication rate, shorter operation time, and hospitalization period.