A Meta-analysis To Compare The Efficacy Of The Two Surgical Methods In The Treatment Of Chiari?Malformation

Objective:Using Meta-analysis to systematically evaluate the clinical efficacy,advantages and disadvantages of the two surgical methods of posterior fossa decompression with duraplasty(control)and posterior fossa decompression with duraplasty and cerebellar tonsil resection(experimental group)in the treatment of Chiari malformation type?.Methods:We searched English databases:the Pubmed,Cochrance,Spring Link,Science Direct.And Chinese databases:CNKI,WanFang Data and VIPC databases.The literature is eliminated through PRISMA flow diagram,selected accordance to inclusion and exclusion criteria.The data of general characteristics are summarized and extracted,used the Newcastle-Ottawa Scale to evaluate the quality of the included studies.Using Stata14.0 software for Meta-analysis of the data,and drawn funnel plot and forest.Results:Eleven Chinese retrospective cohort studies involving 818 patients are included.Posterior fossa decompression combined with duraplasty(control group)is including in 424 patients,posterior fossa decompression and duraplasty combined with cerebellar tonsillectomy(experimental group)is including in 394 patients.The results of Meta analysis is showed that compared with the control group,the experimental group has a significantly improved in the clinical symptoms(OR =2.045,95%CI:1.303—3.210,P=0.002);and a higher rate of postoperative fever(OR=1.719,95%CI:1.013—2.917,P = 0.044);and a higher rate of headache(OR =1.563,95%CI:1.011—2.419,P = 0.045);and a higher rate of cerebrospinal fluid—related complications(OR=1.951,95%CI:1.145—3.327,P=0.014).But there is no significant difference in syringomyelia reduction(P=0.906),symptoms improved inlong-term(P=0.113),intracranial infection(P=0.101),wound infection(P=0.654)and subcutaneous effusion(P=0.172),between the control group and experimental group.Conclusion:The clinical symptoms is significantly improved in the experimental group,but there are more complications.At the same time,there was no difference in long-term symptoms and syringomyelia reduction.Combined with the above factors,posterior fossa decompression and dura plasty combined with cerebellar tonsillectomy are not recommended in the treatment of Chiari I malformation.Due to the lack of randomized controlled trials and deficiencies in this paper,further verification is still needed to provide higher evidence for clinical treatment.