| Abstrakt: |
BACKGROUND: Most surgeons practice a suboccipital craniectomy with duraplasty for the treatment of patients with Chiari malformation I (CM-I). However, duraplasty could impose several operative hazards ranging from hypotensive headache up to fatal meningitis. Dura-splitting decompression can achieve comparable clinical outcome, yet with higher safety profile. OBJECTIVE: The aim of this study is to analyze the clinical and radiological outcomes following dura-splitting decompression in CM-I patients, compared to the standard duraplasty technique. PATIENTS AND METHODS: This is a retrospective study of 84 patients with CM-I who had surgery between January 2015 and August 2021. Patients were divided into two groups following bony decompression; the first group had splitting of the outer layer of the dura, whereas the second group had duraplasty. Data collected including patients’ demographic data, preoperative clinical evaluation, operative data, and postoperative clinical and radiological outcomes were tabulated and analyzed. RESULTS: The study included 84 patients with CM-I who underwent suboccipital craniectomy; 44 patients (52.4%) had dural splitting and 40 patients (47.6%) underwent duraplasty. Mean age at presentation was similar in both groups, 38 years in the dura-splitting group and 40 years in the duraplasty group. There were 59 female patients (70.2%). The mean follow-up period was 17.2 months (range, 12-37 months). Both techniques achieved comparable clinical and radiological outcomes. Durasplitting decompression achieved less blood loss and shorter hospital stay. Dura-splitting technique had statistically significant less postoperative complications (p> 0.05) and less operative time (p >0.05). There was no statistically significant difference as regards the clinical improvement or adequate posterior fossa decompression. CONCLUSION: Dura-splitting technique provides comparable clinical and radiological improvement in CM-I patients compared to duraplasty, with more safety, less operative time and blood loss, and shorter hospital stays. [ABSTRACT FROM AUTHOR] |
