EREN GÖRKEM GÜN, ŞANSER GÜL
Kastamonu Medical Journal - 2022;2(4):113-118
Aim: A standard surgical technique has not been developed for Chiari Type-1 malformation. Recently, dural-splitting has also been introduced in addition to duraplasty. We aimed to determine both surgical techniques’ advantages/disadvantages clinically and radiologically. Material and Method: We retrospectively evaluated 28 patients’ data with Chiari Type-I malformation and operated at the Neurosurgery Department of Bülent Ecevit University between January 2014 and April 2018. We retrieved demographic characteristics, symptoms, physical/neurological findings, preoperative/postoperative imaging data/measurements, Visual Analog Scale, Chicago Chiari Outcome Scale, Neck Disability Index, Neurological Scoring System, and the modified Japanese Orthopedic Association scores, operation and hospitalization times, and complications from the automation system. Results: Patients’ mean age was 38.5±13.0 years, and female/male ratio was 2.1/1. Syringomyelia was present in half of all cases. Mean tonsil herniation length was 11.64±4 mm, and mean tonsillo-dural distance was 4.18±1.7 mm. There were no significant relationships between tonsil herniation length and syringomyelia, and between tonsillo-dural distance and clinical improvement. Posterior fossa decompression was initially performed in all patients. Then, in 17 patients, duraplasty was performed. In 11 patients, dural-splitting was used. No significant differences were determined between duraplasty and duralsplitting regarding Visual Analog Scale, Chicago Chiari Outcome Scale, Neck Disability Index, Neurological Scoring System, and the modified Japanese Orthopedic Association scores. Significant differences were present, favoring dural-splitting regarding operation time, hospital stay, and complication rates. Conclusion: Posterior fossa decompression/duraplasty is an effective surgical technique to treat Chiari Type-I malformation. Posterior fossa decompression/dural-splitting is an optimal surgical alternative with a lower complication rate, shorter operation time, and hospitalization period.
