Perioperative outcomes and complications associated with allogeneic duraplasty for the management of Chiari malformations Type I in 48 pediatric patients

Clinical article

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  • Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Object

The authors debate the optimal management for Chiari malformation Type I (CM-I) while sharing their experience with posterior fossa decompression and duraplasty (PFDD).

Methods

The charts of 48 consecutive pediatric patients surgically treated for CM-I were retrospectively reviewed.

Results

Patients ranged in age from 2 to 17 years with an average age of 9.8 years. The most common presentations were headache, affecting 34 patients (71%), and pain (neck, back, or extremities), affecting 21 patients (44%). Twenty-seven patients (56%) had a syrinx. All 48 patients underwent PFDD utilizing acellular tissue matrix. The average hospital stay overall was 3.56 days, whereas the average stay for patients with (29 [60%] of 48) or without (19 [40%] of 48) scoliosis and/or syringomyelia was 3.72 and 3.32 days, respectively. The odds of a patient having a hospital stay of 4 or more days was nearly 3 times greater in patients with scoliosis and/or syringomyelia as compared with patients without either condition (OR 2.73, 95% CI 0.74–10.11, p = 0.1330). The average hospital stay for patients 0–8 years of age was 3.29 days; and for those 9–17 years of age, 3.78 days. The odds of a patient having a hospital stay of 4 or more days was nearly 4 times greater in 9- to 17-year-olds as compared with 0- to 8-year-olds (OR 3.73, 95% CI 1.03–13.52, p = 0.0455). Forty patients (89%) experienced early improvement in their signs and symptoms following PFDD. There were 2 revision PFDDs (4%).

Conclusions

Posterior fossa decompression and duraplasty is a safe and effective surgical option in the management of pediatric CM-I.

Abbreviations used in this paper:CM-I = Chiari malformation Type I; PFD = posterior fossa decompression; PFDD = PFD and duraplasty; PICA = posterior inferior cerebellar artery; VP = ventriculoperitoneal.

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Contributor Notes

Address correspondence to: Sam Safavi-Abbasi, M.D., Ph.D., Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 North Lincoln Boulevard, Suite 400, Oklahoma City, Oklahoma 73104. email: Sam-Safavi@ouhsc.edu.

Please include this information when citing this paper: published online June 29, 2012; DOI: 10.3171/2012.5.PEDS11406.

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