The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: A systematic review and meta-analysis of surgical and performance outcomes

Victor M. Lu, Kevin Phan, Sean P. Crowley, David Daniels

Research output: Contribution to journalReview article

32 Scopus citations

Abstract

OBJECTIVE Surgery is the definitive treatment of Chiari malformation Type I (CM-I). It involves posterior fossa decompression, which can be performed along with C-1 laminectomy, reconstructive duraplasty, or tonsil shrinkage. The aim of this study was to provide an updated systematic review and meta-analysis of the latest available evidence regarding posterior fossa decompression only (PFDO) versus posterior fossa decompression with duraplasty (PFDD) in the treatment of CM-I in children. METHODS A literature search was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for article identification, screening, eligibility, and inclusion. Relevant articles were identified from 6 electronic databases from their inception to April 2016. These articles were screened against established criteria for inclusion into this study. RESULTS From 12 relevant studies identified, 1492 pediatric patients treated via PFDD were compared with 1963 pediatric patients treated by PFDO for CM-I. PFDD was associated with greater overall clinical improvement (p = 0.0009), along with longer length of stay (p < 0.0001) and more postoperative complications (p = 0.0001) compared with PFDO. No difference was observed between PFDD and PFDO in terms of revision surgery incidence (p = 0.13), estimated blood loss (p = 0.14), syrinx improvement (p = 0.09), or scoliosis improvement (p = 0.95). CONCLUSIONS It appears that the addition of duraplasty to posterior decompression in the definitive treatment of CM-I in children may alter surgical and performance outcomes. In particular, parameters of overall clinical improvement, length of stay, and postoperative complication may differ between children undergoing PFDD and those undergoing PFDO. Current evidence in the literature is of low to very low quality that, as of yet, has not been able to completely control for inherent selection bias both in study design and surgeon preference. Future, large prospective registries and randomized controlled trials are warranted to validate the findings of this study.

Original languageEnglish (US)
Pages (from-to)439-449
Number of pages11
JournalJournal of Neurosurgery: Pediatrics
Volume20
Issue number5
DOIs
StatePublished - Nov 1 2017

Keywords

  • Chiari malformation
  • Decompression
  • Dural graft
  • Duraplasty
  • Meta-analysis
  • Pediatrics
  • Surgery
  • Systematic review

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Fingerprint Dive into the research topics of 'The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: A systematic review and meta-analysis of surgical and performance outcomes'. Together they form a unique fingerprint.

  • Cite this