Comparison of clinical and radiologic outcomes between dural splitting and duraplasty for adult patients with Chiari type I malformation

Abstract

Background: The most used surgical procedure in the treatment of patients with Chiari type I malformation (CIM) is posterior fossa decompression. However, no consensus has been reached regarding the superiority of either dural splitting or duraplasty. Thus, the aim of this study was to compare clinical and radiologic outcomes between the two techniques used in consecutive patients. Methods We retrospectively reviewed 74 adult patients with CIM who were diagnosed and treated surgically between 2015 and 2020 at our neurosurgery department. The patients were divided into two groups: dural splitting in group 1 and duraplasty in group 2. Clinical outcomes based on Chicago Chiari Outcome Scale (CCOS) scores at the last control visits were compared between the groups. Radiologic outcomes were compared in terms of tonsillar regression rate based on 12-postoperative-month magnetic resonance images. Results: Overall improved, unchanged, and worsened neurologic statuses were observed in 75.6% ( n = 56), 17.5% ( n = 13), and 6.7% ( n = 5) of our patients, respectively. The mean last visit CCOS scores in groups 1 and 2 were 12.3 +/- 2.1 and 13.5 +/- 1.7, respectively. The difference between the groups was statistically significant ( p < 0.01). The mean tonsillar regression rates were 34.7 +/- 17.0% and 52.1 +/- 15.3% in groups 1 and 2, respectively, with a statistically significant difference ( p < 0.001). Conclusion: Adult patients undergoing duraplasty had better clinical and radiologic outcomes than those treated with dural splitting. Therefore, we recommend decompression with duraplasty for adult CIM patients.