Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I

First author:Xiaofeng Deng, Chenlong Yang

Corresponding author:Yulun Xu

Small-bone-window posterior fossa decompression wi

essential_information

2015-10-01

Published articles

Journal:World Neurosurgery

Publication type: Original Article

IF(IF): 2.104

PMID: 25701768 Link To Pubmed

Background And Purpose

Method

Small-bone-window posterior fossa decompression with duraplasty is one of the popular surgical options for Chiari malformation type I, but its efficacy is controversial and the risk factors of clinical outcome remain unclear.

Conclusion

The average follow-up duration was 74 months. Symptoms were improved in 126 patients (82.9%), remained stable in 21 patients (13.8%), and deteriorated in 5 patients (3.3%). There was no mortality. Postoperative magnetic resonance imaging scans were available for all patients. Preoperatively, 112 patients were associated with syringomyelia, and the follow-up magnetic resonance images showed obvious reduction of syringomyelia in 73 patients (65.2%) and no significant change in 39 patients (34.8%). In addition, enlargement of the cistern magna was observed in 92 patients (85.2%). Regression analysis indicates preoperative motor dysfunction, brainstem herniation and basilar invagination may influence the clinical outcome (P < 0.05).

Main results

The study cohort included 152 patients with Chiari malformation type I who received small-bone-window posterior fossa decompression at Beijing Tiantan hospital from January 2008 to September 2009. All patients underwent combined surgical procedures: a small-bone-window suboccipital decompression (diameter, 2.5-3 cm) and a C1 laminectomy (1.5- to 2-cm wide) followed by a duraplasty with an autologous graft. Clinical manifestations, radiologic features, and follow-up data during a 6-year span were analyzed. Risk factors associated with outcome were investigated by the use of ?(2) analysis and logistic regression analysis.