A Meta Analysis Of Comparison Of Posterior Fossa Decompression With And Without Duraplasty For The Surgical Treatment Of Chiari Malformation Type ? Patients

Background:Chiari malformation is a group of congenital brain abnormalities with tonsillar herniation into the foramen magnum,Chari malformation is divided into four types,type I-IV.Type I is the most common type.Surgery is the mainly treatment posterior fossa decompression with duraplasty and without duraplasty is the most common surgery method.which is better,It is controversial.Objective: The aim of this analysis is comparing the clinical efficacy of two surgical methods for the treatment of Chiari malformation,including the incidence of complications,the rate of reduction of-I and the improvement of clinical symptoms.Methods:Search the The MEDLINE(Ovid),PubMed,CNKI and WanFang Data database from September 2000 to September 2016 for the published papers.there are12 retrospective cohort studies,and 4 prospective cohort studies included.Evoluation method:Two reviewers select the literature independently according to the inclusion and exclusion criteria.screen them out and summarize them.Use stata software to do the meta analysis for the data and GRADE system was used to evaluate the quality of evidence.Results: 1.The reduction rate of Syringomyelia of duraplasty groups is higher than the posterior fossa decompress groups,[RR=1.359,95%CI(1.087,1,698),P<0.05]2.There was no significant difference in the improvement rate of clinical symptoms after the operation between two groups[RR=1.002 CI(0.934,1.074),P=0.969],3.Complication rate of dura plasty groups is higher than the posterior fossa decompress groups[RR=2.337 CI(1.666,3.278),P=0.00].Conclusion: System evaluation based on the above results,posterior fossa decompression and dural plasty group than the simple posterior fossa decompression group has a higher remission rate of syringomyelia,but the former was highter than the latter about the incidence of postoperative complications,The improvement rate vof clinical symptoms had no significant difference between the two groups.