Comparison Of Two Surgical Methods For The Treatment Of Chiari Malformation Ⅰ-meta Analysis

Objective: Arnold-Chiari malformation type I(CM-I)is a common congenital deformity of the posterior cranial fossa,which can be found both in children and adults.Some patients is complicated by the syringomyelia.Posterior fossa decompression is an effective treatment for patients with obvious symptoms and signs,but there is still a lot of controversy about the specific operation.The purpose of this systematic review and meta-analysis is to compare the outcomes of patients who undergone posterior fossa decompression with duraplasty(PFDD)or dura splitting decompression(DSD).These outcome mearsures include relief of symptoms or signs,incidence of surgical complications,reduction of syringomyelia,and the rate of reoperation.Methods: Literatures published from January 1st,2005 to December 31 st,2015 in Pub Med,EMBASE,Cochrane,Wanfang,CNKI database were searched by two researchers,respectively.According to the inclusion and exclusion criteria,these literatures were screened and the quality of included studies were evaluated by the Newcastle-Ottawa scale.Then two researchers extracted data and analyzed the data with Rev Man 5.3 software.Results: Five articles were included in this study.There were a total of 230 cases,including DSD group(n =129)and PFDD group(n = 101).The studies were analyzed by using a fixed effects model.Results showed that there was no significant difference in improvement of clinical symptoms or signs [OR=0.69,95%CI(0.33,1.42),P=0.31],syringomyelia reduction [OR= 0.94,95%CI(0.29,3.11),P=0.92],and reoperation rate [OR=0.53,95%CI(0.13,2.15),P=0.37] between PFDD group and DSD group.While patients undergone DSD had a significantly lower incidence of surgical complications [OR=0.29,95%CI(0.09,0.91),P=0.03],when compared with patients undergone PFDD.Conclusion: Except lower incidence of complications of DSD,there was no significant difference in improvement of clinical symptoms or signs,syringomyelia reduction,and reoperation rate in the two surgical methods for the treatment of CM-I.However,the number of included original research was too little,the above conclusions may need to be further verified by multi center,large sample RCT.