Efficacy Of Posterior Fossa Decompression Without Duraplasty For Chari Ⅰ Malformation With Syringomyelia

Background. The indication for surgery, surgical methods and surgical efficacy of Chiari I malformation (CIM) has always been controversial. Posterior Fossa Decompression without Duraplasty (PFD) has increasingly been recognized by the academic community. Many clinical centers abroad have carried out this through retrospective randomized controlled study. However, relative clinical reports in China are still rare.Objective. To investigate the clinical effect of PFD for CIM combined with syringomyelia.Methods. The authors performed a retrospective review of 17 cases of CIM combined with syringomyelia from 2008 to 2010. Data were analyzed for clinical presentation, surgical procedures, surgical complications, mean operative time, length of stay, total hospital costs and outcome.Results. Of 17 unique patients,10 underwent PFD,4 patients underwent Posterior Fossa Decompression with Duraplasty (PFDD) and the other 3 patients refused surgery. Patients treated with PFDD had an average operative time of 140 minutes in contrast to 104 minutes for those who underwent PFD. Patients treated with PFDD had average postoperative hospital stays of 21 days, whereas that for patients treated with PFD was 8.9 days. Patients treated with PFDD had average hospital cost of 28,797 Yuan, while that for patients treated with PFD was 18,849 Yuan. None of postoperative complications in 10 patients who treated with PFD, however, all of 4 patients treated with PFDD occurred intracranial infection and one of them occurred cerebrospinal fluid leakage.Conclusions. Almost the same clinical outcomes can be achieved with and without duraplasty. There might be an option to perform duraplasty if PFD fails. However, it is still necessary to develop a standard surgical treatment for CIM through multi-center randomized controlled study and long-term follow-up observations.