Comparision Of Surgical Results Between Posterior Fossa Decompression With And Without Duraplasty For Patients With Chiari Malformation Type ?:A Systematic Review And Meta-analysis

Purpose: Posterior fossa decompression with(PFDD)or without duraplasty(PFD)for patients with Chiari malformation type 1(CM-I)is controversial.Thus,we made a systematic review and meta-analysis of reports to assess the effect on clinical and imaging improvement,operative time,complications and recurrence rate between PFD and PFDD in patients with CM-I.Method: We systematically searched PubMed,Embase,Cochrane,Web of Knowledge,ClinicalTrials.gov,CNKI and Google Scholar for Retrospective or prospective studies comparing PFD to PFDD.Our main endpoints were clinical and imaging improvement,operative time,complications and recurrence rate.Result: Of 214 identified studies,13 were eligible and were included in our analysis(N=3481 patients).Compared to PFD,PFDD led to a mean greater increase in operative time [SMD=-2.35,95%CI(-2.70,-1.99)],a higher likelihood of clinical improvement in patients with syringomyelia [RR=0.70,95%CI(0.49,0.98)],no increased relative risk of clinical improvement in patients without syringomyelia,no increased relative risk of imaging improvement,but an increased relative risk of CSF-related complications [RR=0.29,95%CI(0.15,0.58)],CSF leak,aseptic meningitis and pseudomeningocele,and an decreased likelihood of recurrence rate..Conclusion: PFDD can be an optimal surgical strategy for its higher clinical improvement and lower recurrence rate in the patients with syringomyelia.PFD can be a preferred choice for its similar clinical improvement and lower costs in the patients without syringomyelia.Future randomized studies with large numbers and the power to provide illumination for the surgical decision-making of CM-I are warranted.