Abstract
Objectives
Few studies are available that directly compare dural opening with and without additional intradural maneuvers. Therefore, the current review analyzed the available literature regarding this topic.
Methods
An Ovid MEDLINE search was completed using each of the terms “Chiari malformation,” “syringomyelia,” “syrinx,” “syringohydromyelia” in combination with “child” or “pediatric.” Publications were considered relevant if they reported the results of posterior fossa decompression without dural opening (PFD) to posterior fossa decompression with duraplasty (PFDD). The included studies were divided into three categories based upon the surgical techniques studied. The first group of papers included works that directly compared PFD to PFDD. The second group included studies in which all patients were treated with PFD. The third group included studies in which all patients were treated with PFDD. Three outcome parameters were assessed: (1) improvement of clinical signs/symptoms, (2) syrinx resolution, and (3) scoliosis progression.
Results
At this time, there is no level I or IIa evidence comparing PFD with PFDD. The notions that PFDD has a lower rate of reoperation and that PFD has a lower rate of cerebrospinal fluid-related complications are both based on IIb/B evidence.
Conclusions
Prospective randomized trials are necessary for definitive comments regarding the success of PFD and PFDD.
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References
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:E3
Anderson RC, Dowling KC, Feldstein NA, Emerson RG (2003) Chiari I malformation: potential role for intraoperative electrophysiologic monitoring. J Clin Neurophysiol 20:65–72
Anderson RC, Emerson RG, Dowling KC, Feldstein NA (2003) Improvement in brainstem auditory evoked potentials after suboccipital decompression in patients with Chiari I malformations. J Neurosurg 98:459–464
Attenello FJ, McGirt MJ, Atiba A, Gathinji M, Datoo G, Weingart J et al (2008) Suboccipital decompression for Chiari malformation-associated scoliosis: risk factors and time course of deformity progression. J Neurosurg Pediatr 1:456–460
Attenello FJ, McGirt MJ, Gathinji M, Datoo G, Atiba A, Weingart J et al (2008) Outcome of Chiari-associated syringomyelia after hindbrain decompression in children: analysis of 49 consecutive cases. Neurosurgery 62:1307–1313, discussion 1313
Attenello FJ, McGirt MJ, Garces-Ambrossi GL, Chaichana KL, Carson B, Jallo GI (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
Brockmeyer D, Gollogly S, Smith JT (2003) Scoliosis associated with Chiari 1 malformations: the effect of suboccipital decompression on scoliosis curve progression: a preliminary study. Spine 28:2505–2509 (Phila Pa 1976)
Caldarelli M, Novegno F, Vassimi 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
Danish SF, Samdani A, Hanna A, Storm P, Sutton L (2006) Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. J Neurosurg 104:16–20
Doughty KE, Tubbs RS, Webb D, Oakes WJ (2004) Delayed resolution of Chiari I-associated hydromyelia after posterior fossa decompression: case report and review of the literature. Neurosurgery 55:711
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
Ellenbogen RG, Armonda RA, Shaw DW, Winn HR (2000) Toward a rational treatment of Chiari I malformation and syringomyelia. Neurosurg Focus 8:E6
Eule JM, Erickson MA, O’Brien MF, Handler M (2002) Chiari I malformation associated with syringomyelia and scoliosis: a twenty-year review of surgical and nonsurgical treatment in a pediatric population. Spine 27:1451–1455 (Phila Pa 1976)
Farley FA, Puryear A, Hall JM, Muraszko K (2002) Curve progression in scoliosis associated with Chiari I malformation following suboccipital decompression. J Spinal Disord Tech 15:410–414
Feldstein NA, Choudhri TF (1999) Management of Chiari I malformations with holocord syringohydromyelia. Pediatr Neurosurg 31:143–149
Fischer EG (1995) Posterior fossa decompression for Chiari I deformity, including resection of the cerebellar tonsils. Childs Nerv Syst 11:625–629
Flynn JM, Sodha S, Lou JE, Adams SB Jr, Whitfield B, Ecker ML et al (2004) Predictors of progression of scoliosis after decompression of an Arnold Chiari I malformation. Spine 29:286–292 (Phila Pa 1976)
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
Genitori L, Peretta P, Nurisso C, Macinante L, Mussa F (2000) Chiari type I anomalies in children and adolescents: minimally invasive management in a series of 53 cases. Childs Nerv Syst 16:707–718
Ghanem IB, Londono C, Delalande O, Dubousset JF (1997) Chiari I malformation associated with syringomyelia and scoliosis. Spine 22:1313–1317, (Phila Pa 1976); discussion 1318
Haroun RI, Guarnieri M, Meadow JJ, Kraut M, Carson BS (2000) Current opinions for the treatment of syringomyelia and chiari malformations: survey of the pediatric section of the American Association of Neurological Surgeons. Pediatr Neurosurg 33:311–317
Hayhurst C, Osman-Farah J, Das K, Mallucci C (2008) Initial management of hydrocephalus associated with Chiari malformation type I-syringomyelia complex via endoscopic third ventriculostomy: an outcome analysis. J Neurosurg 108:1211–1214
Hida K, Iwasaki Y, Koyanagi I, Abe H (1999) Pediatric syringomyelia with chiari malformation: its clinical characteristics and surgical outcomes. Surg Neurol 51:383–390, discussion 390-381
Hoffman CE, Souweidane MM (2008) Cerebrospinal fluid-related complications with autologous duraplasty and arachnoid sparing in type I Chiari malformation. Neurosurgery 62:156–160, discussion 160-151
Huebert HT, MacKinnon WB (1969) Syringomyelia and scoliosis. J Bone Joint Surg Br 51:338–343
Isu T, Chono Y, Iwasaki Y, Koyanagi I, Akino M, Abe H et al (1992) Scoliosis associated with syringomyelia presenting in children. Childs Nerv Syst 8:97–100
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
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
McGirt M, Attenello F, Chaichana K, Weingart JD, Carson BS, Jallo GI (2007) Duraplasty versus cranial decompression alone reduces treatment failure for pediatric Chiari I malformation patient with tonsillar herniation caudal to C1 but does not affect outcome in patients with tonsillar herniation rostral to C1. Neurosurgery 61:208 (Abstract 843)
McGirt MJ, Attenello FJ, Datoo G, Gathinji M, Atiba A, Weingart JD et al (2008) Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with Chiari malformation Type I. J Neurosurg Pediatr 2:52–57
Muhonen MG, Menezes AH, Sawin PD, Weinstein SL (1992) Scoliosis in pediatric Chiari malformations without myelodysplasia. J Neurosurg 77:69–77
Munshi I, Frim D, Stine-Reyes R, Weir BK, Hekmatpanah J, Brown F (2000) Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia. Neurosurgery 46:1384–1389, discussion 1389–1390
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
Ozerdemoglu RA, Transfeldt EE, Denis F (2003) Value of treating primary causes of syrinx in scoliosis associated with syringomyelia. Spine 28:806–814 (Phila Pa 1976)
Park JK, Gleason PL, Madsen JR, Goumnerova LC, Scott RM (1997) Presentation and management of Chiari I malformation in children. Pediatr Neurosurg 26:190–196
Schijman E, Steinbok P (2004) International survey on the management of Chiari I malformation and syringomyelia. Childs Nerv Syst 20:341–348
Sengupta DK, Dorgan J, Findlay GF (2000) Can hindbrain decompression for syringomyelia lead to regression of scoliosis? Eur Spine J 9:198–201
Tubbs RS, McGirt MJ, Oakes WJ (2003) Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg 99:291–296
Tubbs RS, Webb DB, Oakes WJ (2004) Persistent syringomyelia following pediatric Chiari I decompression: radiological and surgical findings. J Neurosurg 100:460–464
Tubbs RS, Doyle S, Conklin M, Oakes WJ (2006) Scoliosis in a child with Chiari I malformation and the absence of syringomyelia: case report and a review of the literature. Childs Nerv Syst 22:1351–1354
Ventureyra EC, Aziz HA, Vassilyadi M (2003) The role of cine flow MRI in children with Chiari I malformation. Childs Nerv Syst 19:109–113
Wetjen NM, Heiss JD, Oldfield EH (2008) Time course of syringomyelia resolution following decompression of Chiari malformation Type I. J Neurosurg Pediatr 1:118–123
Williams B (1979) Orthopaedic features in the presentation of syringomyelia. J Bone Joint Surg Br 61:314–323
Yeh DD, Koch B, Crone KR (2006) Intraoperative ultrasonography used to determine the extent of surgery necessary during posterior fossa decompression in children with Chiari malformation type I. J Neurosurg 105:26–32
Zamel K, Galloway G, Kosnik EJ, Raslan M, Adeli A (2009) Intraoperative neurophysiologic monitoring in 80 patients with Chiari I malformation: role of duraplasty. J Clin Neurophysiol 26:70–75
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Hankinson, T., Tubbs, R.S. & Wellons, J.C. Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation. Childs Nerv Syst 27, 35–40 (2011). https://doi.org/10.1007/s00381-010-1295-7
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DOI: https://doi.org/10.1007/s00381-010-1295-7