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Dura Splitting Decompression for Chiari I Malformation in Pediatric Patients: Clinical Outcomes, Healthcare Costs, and Resource Utilization

Litvack, Zachary N. MD, MCR; Lindsay, Rebecca A. MD; Selden, Nathan R. MD, PhD

Neurosurgery:
doi: 10.1227/NEU.0b013e31828ca1ed
Research-Human-Clinical Studies
Abstract

BACKGROUND: Dural splitting decompression may be an effective and safe treatment for Chiari I malformation.

OBJECTIVE: To compare clinical outcomes, complications, and resource utilization for patients undergoing Chiari I decompression with or without duraplasty.

METHODS: Between 2000 and 2009, the senior author performed 113 Chiari I decompression operations with dural splitting or duraplasty in children less than 18 years of age; 110 were included in a retrospective cohort analysis of safety, efficacy, and treatment cost. Patients without significant syringomyelia underwent dural splitting decompression, and patients with syringomyelia underwent duraplasty.

RESULTS: Sixty-three patients without significant syringomyelia (57%) underwent dural splitting decompression. They were significantly younger than patients undergoing duraplasty (8.3 ± 4.9 years vs 10.4 ± 4.4 years; P < .05). Headaches improved or resolved in most patients in both groups (90.5% vs 93.6%; P = .59). Dysphagia, long tract signs, cranial nerve, and bulbar symptoms also improved similarly in both groups. Three duraplasty patients were treated medically for aseptic meningitis; one underwent reoperation for a symptomatic pseudomeningocele. No patient undergoing dural splitting decompression experienced a cerebrospinal fluid-related complication. Extradural decompression required less operative time than duraplasty (105.5 vs 168.9 minutes, P < .001), a shorter length of stay (2.4 vs 2.8 days, P = .011), and lower total cost for the primary hospitalization ($26 837 vs $29 862, P = .015).

CONCLUSION: In this retrospective cohort study, dural splitting decompression was equally effective, safer, and lower cost for treatment of Chiari I malformation without syringomyelia. A multicenter trial with groups balanced for the presence of syringomyelia is necessary to determine whether these results are generalizable.

ABBREVIATION: CI, confidence interval

Author Information

Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon

Correspondence: Nathan R Selden, MD, PhD, Department of Neurological Surgery, Mail Code CH8N, Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR 97239. E-mail: seldenn@ohsu.edu

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Received June 28, 2012

Accepted January 29, 2013

Copyright © by the Congress of Neurological Surgeons