The symposium is co-organised by The Ann Conroy Trust, in association with Aesculap Academia.
The Ann Conroy Trust is Registered Charity No: 1165808.
We provide Support, Education and Research for patients living with Chiari Malformation, Syringomyelia and associated conditions.
F10 Chiari malformation type 1: a review of literature to compare bony posterior fossa decompression with and without duraplasty.
Foroughi M, Tam S.
Two main surgical approaches for symptomatic Chiari type I malformation (CM-I) patients are posterior fossa decompression involving craniectomy alone (PFD), and posterior fossa decompression with duraplasty (PFDD). The aim of this review was to outline the indications, advantages and disadvantages of each surgical approach, with guidance regarding surgical decisions.
We reviewed pertinent articles, retrieved by searching in the PubMed and Embase databases. Inclusion and exclusion criteria were predefined. Data on the surgical outcomes, complications, re-operations, duration of procedure and the length of hospital stay were compared.
Eighteen articles, containing data on 2,840 paediatric and adult participants, met the inclusion criteria. PFDD was associated with more favourable surgical outcomes. Regarding radiological outcomes, syrinx reduction was observed in 92.3% PFDD vs 12.5% PFD (p= 0.001). On the other hand, PFD was associated with lower complications rates. The rate of postoperative aseptic meningitis was 6.1% in PFD vs 27.1% (p=0.027) in PFDD, and the rate of procedural-related complication was 0.8% in PFD vs 2.3% in PFDD (p=0.008). However, PFD was linked to higher rates of re-operation with an odds ratio of 0.15 in PFDD vs PFD (p=0.002).
Both PFD and PFDD are effective and safe surgical strategies for symptomatic CM-I, associated with posterior fossa volume mismatch and in the absence of hydrocephalus and craniocervical region instability. Bony PFD has a lower complication rate, and seems to be good option when carried out in the paediatric age group, in individuals without major tonsillar impaction, and in the absence of a syrinx. However, these patients should be adequately counselled regarding the requirement for possible further, intra-dural decompression