Duraplasty Versus Non-dural Opening for the Treatment of Pediatric Chiari Malformation, Type I

Ajani, Olufemi; Hankinson, Todd C.

doi:10.1007/978-1-4614-6369-6_33

Cited by 1 publication

(2 citation statements)

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“…Furthermore, associated comorbidities, orthopedic deformities, or other congenital malformations may play an indispensable role in the functional outcome following decompression surgery. A higher reoperation rate and worse clinical outcomes in CM with other associated congenital malformations have been noted in previous studies, and the outcomes of scoliosis seemed to correlate with the outcomes of syringomyelia 21,22. However, there is still a paucity of large-scale literature concerning the relations between other associated comorbidities and surgical outcomes.…”

Section: Discussionmentioning

confidence: 81%

“…A higher reoperation rate and worse clinical outcomes in CM with other associated congenital malformations have been noted in previous studies, and the outcomes of scoliosis seemed to correlate with the outcomes of syringomyelia. 21,22 However, there is still a paucity of large-scale literature concerning the relations between other associated comorbidities and surgical outcomes. Thus, a further assessment for CM concerning the concomitant structural complications of the disease, not just the complications associated with the surgeries, may be necessary for a thorough scoring system for surgical outcomes of CM.…”

Section: Discussionmentioning

confidence: 99%

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One-Year Outcomes of Chiari Type 1 Malformation and Syringomyelia Treated With Posterior Fossa Decompression

Han¹,

Gao²,

Li³

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Objective: The objective of this study was to evaluate posterior fossa structural differences between Chiari type 1 malformation with and without syringomyelia, and assess data of the improvement of syringomyelia after different surgical options.Summary of Background Data: Syringomyelia is among the most common concomitant complications of Chiari malformation (CM). However, posterior fossa decompression cannot definitely make the syringomyelia disappear even in the long term. Also, there are no universal criteria defining improvement in syrinx.Materials and Methods: All admitted CM patients at our institution from 2013 to 2018 with a 1-year follow-up were analyzed. Patients without syringomyelia were compared with those who had syringomyelia. Patients were divided into 3 groups according to the procedures performed: posterior fossa decompression versus posterior fossa decompression with duralplasty (PFDD) versus PFDD plus obex unblocking. Divergent prognosis of syringomyelia was defined as a 3-category ordinal variable. A multivariable ordinal regression model was used to estimate the relationship between patient variables and increased odds for better resolution of syringomyelia.Results: No significant linear difference in bony structure was found between syringomyelia and nonsyringomyelia patients. Among syringomyelia patients, the regression analysis demonstrated that patients with shorter posterior fossa height (P = 0.032), lower Pavlov ratio (P = 0.029), and obex unblocking (vs. PFDD, P < 0.001; vs. posterior fossa decompression, P = 0.037) were more likely to gain a better resolution of syringomyelia.Conclusions: Syringomyelia of CM patients may not simply originate from single linear anatomic variation. Patients with shorter posterior fossa height and lower Pavlov ratio received better syringomyelia resolution. Also, unblocking the obex received better syringomyelia resolution compared with duraplasty alone and bony decompression alone with the avoidance of increased postoperative complications and worse clinical outcomes.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%