Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium

S. Hassan A. Akbari MD, MS1, Alexander T. Yahanda MD2, Laurie L. Ackerman MD3, P. David Adelson MD4, Raheel Ahmed MD, PhD5, Gregory W. Albert MD, MPH6, Philipp R. Aldana MD7, Tord D. Alden MD8, Richard C. E. Anderson MD9, David F. Bauer MD10, Tammy Bethel-Anderson2, Karin Bierbrauer MD36, Douglas L. Brockmeyer MD11, Joshua J. Chern MD, PhD12, Daniel E. Couture MD13, David J. Daniels MD, PhD14, Brian J. Dlouhy MD15, Susan R. Durham MD16, Richard G. Ellenbogen MD17, Ramin Eskandari MD18, Herbert E. Fuchs MD, PhD19, Gerald A. Grant MD20, Patrick C. Graupman MD21, Stephanie Greene MD22, Jeffrey P. Greenfield MD, PhD23, Naina L. Gross MD24, Daniel J. Guillaume MD25, Todd C. Hankinson MD26, Gregory G. Heuer MD, PhD27, Mark Iantosca MD1, Bermans J. Iskandar MD5, Eric M. Jackson MD28, George I. Jallo MD29, James M. Johnston MD30, Bruce A. Kaufman MD31, Robert F. Keating MD32, Nicklaus R. Khan MD33, Mark D. Krieger MD16, Jeffrey R. Leonard MD34, Cormac O. Maher MD35, Francesco T. Mangano DO36, J. Gordon McComb MD16, Sean D. McEvoy MD2, Thanda Meehan RN2, Arnold H. Menezes MD15, Michael S. Muhlbauer MD33, Brent R. O’Neill MD26, Greg Olavarria MD37, John Ragheb MD38, Nathan R. Selden MD, PhD39, Manish N. Shah MD40, Chevis N. Shannon DrPH41, Joshua S. Shimony MD, PhD42, Matthew D. Smyth MD29, Scellig S. D. Stone MD, PhD43, Jennifer M. Strahle MD2, Mandeep S. Tamber MD, PhD44, James C. Torner PhD15, Gerald F. Tuite MD29, Elizabeth C. Tyler-Kabara MD, PhD45, Scott D. Wait MD46, John C. Wellons III MD, MSPH41, William E. Whitehead MD10, Tae Sung Park MD2, and David D. Limbrick Jr. MD, PhD2
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  • 1 Division of Pediatric Neurosurgery, Penn State Health Children’s Hospital, Hershey, PA;
  • | 2 Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO;
  • | 3 Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN;
  • | 4 Division of Pediatric Neurosurgery, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ;
  • | 5 Department of Neurological Surgery, University of Wisconsin at Madison, Madison, WI;
  • | 6 Division of Neurosurgery, Arkansas Children’s Hospital, Little Rock, AR;
  • | 7 Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, FL;
  • | 8 Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL;
  • | 9 Division of Pediatric Neurosurgery, Department of Neurological Surgery, Children’s Hospital of New York, Columbia-Presbyterian, New York, NY;
  • | 10 Division of Pediatric Neurosurgery, Texas Children’s Hospital, Houston, TX;
  • | 11 Division of Pediatric Neurosurgery, Primary Children’s Hospital, Salt Lake City, UT;
  • | 12 Division of Pediatric Neurosurgery, Children’s Healthcare of Atlanta University, Atlanta, GA;
  • | 13 Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC;
  • | 14 Department of Neurosurgery, Mayo Clinic, Rochester, MN;
  • | 15 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA;
  • | 16 Division of Pediatric Neurosurgery, Children’s Hospital of Los Angeles, Los Angeles, CA;
  • | 17 Division of Pediatric Neurosurgery, Seattle Children’s Hospital, Seattle, WA;
  • | 18 Department of Neurosurgery, Medical University of South Carolina, Charleston, SC;
  • | 19 Department of Neurosurgery, Duke University School of Medicine, Durham, NC;
  • | 20 Division of Pediatric Neurosurgery, Lucile Packard Children’s Hospital, Palo Alto, CA;
  • | 21 Division of Pediatric Neurosurgery, Gillette Children’s Hospital, St. Paul, MN;
  • | 22 Division of Pediatric Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA;
  • | 23 Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY;
  • | 24 Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK;
  • | 25 Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN;
  • | 26 Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO;
  • | 27 Division of Pediatric Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA;
  • | 28 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD;
  • | 29 Division of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL;
  • | 30 Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL;
  • | 31 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI;
  • | 32 Department of Neurosurgery, Children’s National Medical Center, Washington, DC;
  • | 33 Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, TN;
  • | 34 Division of Pediatric Neurosurgery, Nationwide Children’s Hospital, Columbus, OH;
  • | 35 Department of Neurosurgery, University of Michigan, Ann Arbor, MI;
  • | 36 Division of Pediatric Neurosurgery, Cincinnati Children’s Medical Center, Cincinnati, OH;
  • | 37 Division of Pediatric Neurosurgery, Arnold Palmer Hospital for Children, Orlando, FL;
  • | 38 Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL;
  • | 39 Department of Neurological Surgery and Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR;
  • | 40 Division of Pediatric Neurosurgery, McGovern Medical School, Houston, TX;
  • | 41 Division of Pediatric Neurosurgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, TN;
  • | 42 Department of Radiology, Washington University School of Medicine, St. Louis, MO;
  • | 43 Division of Pediatric Neurosurgery, Boston Children’s Hospital, Boston, MA;
  • | 44 Division of Neurosurgery, The University of British Columbia, Vancouver, BC, Canada;
  • | 45 Department of Neurosurgery, The University of Texas at Austin, Austin, TX; and
  • | 46 Carolina Neurosurgery & Spine Associates, Charlotte, NC
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OBJECTIVE

The aim of this study was to determine differences in complications and outcomes between posterior fossa decompression with duraplasty (PFDD) and without duraplasty (PFD) for the treatment of pediatric Chiari malformation type I (CM1) and syringomyelia (SM).

METHODS

The authors used retrospective and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM1-SM who received PFD or PFDD and had at least 1 year of follow-up data. Preoperative, treatment, and postoperative characteristics were recorded and compared between groups.

RESULTS

A total of 692 patients met the inclusion criteria for this database study. PFD was performed in 117 (16.9%) and PFDD in 575 (83.1%) patients. The mean age at surgery was 9.86 years, and the mean follow-up time was 2.73 years. There were no significant differences in presenting signs or symptoms between groups, although the preoperative syrinx size was smaller in the PFD group. The PFD group had a shorter mean operating room time (p < 0.0001), fewer patients with > 50 mL of blood loss (p = 0.04), and shorter hospital stays (p = 0.0001). There were 4 intraoperative complications, all within the PFDD group (0.7%, p > 0.99). Patients undergoing PFDD had a 6-month complication rate of 24.3%, compared with 13.7% in the PFD group (p = 0.01). There were no differences between groups for postoperative complications beyond 6 months (p = 0.33). PFD patients were more likely to require revision surgery (17.9% vs 8.3%, p = 0.002). PFDD was associated with greater improvements in headaches (89.6% vs 80.8%, p = 0.04) and back pain (86.5% vs 59.1%, p = 0.01). There were no differences between groups for improvement in neurological examination findings. PFDD was associated with greater reduction in anteroposterior syrinx size (43.7% vs 26.9%, p = 0.0001) and syrinx length (18.9% vs 5.6%, p = 0.04) compared with PFD.

CONCLUSIONS

PFD was associated with reduced operative time and blood loss, shorter hospital stays, and fewer postoperative complications within 6 months. However, PFDD was associated with better symptom improvement and reduction in syrinx size and lower rates of revision decompression. The two surgeries have low intraoperative complication rates and comparable complication rates beyond 6 months.

ABBREVIATIONS

AP = anteroposterior; CM1 = Chiari malformation type I; CXA = clivoaxial angle; pBC2 = a line perpendicular to a line from the basion to the posteroinferior aspect of the C2 body; PFD = posterior fossa decompression; PFDD = PFD with duraplasty; PRSRC = Park-Reeves Syringomyelia Research Consortium; SM = syringomyelia.

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