Decompression of Chiari malformation with and without duraplasty: morbidity versus recurrence

Clinical article

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Object

The optimal surgical management of Chiari malformation (CM) is evolving. Evidence continues to accrue that supports decompression without duraplasty as an effective treatment to achieve symptomatic relief and anatomical decompression. The risks and benefits of this less invasive operation need to be weighed against decompression with duraplasty.

Methods

The authors performed a retrospective review of all CM decompressions from 2003 to 2007. All operations were performed by a single surgeon at a single institution. Data were analyzed for outcome, postoperative morbidity, and recurrence.

Results

Of 121 unique patients, 56 underwent posterior fossa decompressions without duraplasty (PFD) and 64 patients underwent posterior fossa decompressions with duraplasty (PFDD). Of the 56 PFD patients, 7 (12.5%) needed a subsequent PFDD for symptomatic recurrence. Of the 64 patients who underwent a PFDD, 2 (3.1%) needed a repeated PFDD for symptomatic recurrence. Patients treated with PFDD had an average operative time of 201 minutes in contrast to 127 minutes for those who underwent PFD (p = 0.0001). Patients treated with PFDD had average hospital stays of 4.0 days, whereas that for patients treated with PFD was 2.7 days (p = 0.0001). While in the hospital, patients treated with PFDD used low-grade narcotics, intravenous narcotics, muscle relaxants, and antiemetic medications at statistically significant differing rates.

Conclusions

While PFD was associated with a higher rate of recurrent symptoms requiring repeated decompression, this may be justified by the significantly lower morbidity rate. Clearer delineation of the trade-off between morbidity and recurrence may be used to help patients and their families make decisions regarding care.

Abbreviations used in this paper: CM = Chiari malformation; PFD = posterior fossa decompression; PFDD = PFD with duraplasty.

Article Information

Address correspondence to: Thomas M. Moriarty, M.D., Ph.D., Department of Neurosurgery, Norton Neuroscience Institute, 210 East Gray Street, Suite 1102, Louisville, Kentucky 40202. email: thomas.moriarty@nortonhealthcare.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graph showing the percentage of patients with selected signs and symptoms. The comparison involves all patients versus PFDD versus PFD without duraplasty. Abn gag = abnormal gag reflex; coord = coordination; dyph = dysphagia; HA = headache; incont = incontinence; N/T = numbness and tingling; N/V = nausea and vomiting.

  • View in gallery

    Bar graphs demonstrating mean postoperative, weight-appropriate, administrations of low-grade narcotics (LGN), and intravenous narcotics (IVN) on each of postoperative Days 1, 2, and 3. PFDD compared with PFD without duraplasty.

  • View in gallery

    Bar graphs demonstrating postoperative, weight-appropriate, administrations of muscle relaxants (MR) and antiemetic medication (AE) on each of postoperative Days 1, 2, and 3. PFDD compared with PFD without duraplasty.

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