Comparison of Dural Peeling versus Duraplasty for Surgical Treatment of Chiari Type I Malformation: Results and Complications in a Monocentric Patients' Cohort

• Published in: World neurosurgery Vol. 117; pp. e595 - e602
• Main Authors: Del Gaudio, Nicole, Vaz, Geraldo, Duprez, Thierry, Raftopoulos, Christian
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2018
• Subjects: Chiari malformation type I; Complications; Cranio-cervical decompression; Dural peeling; Duraplasty; Cranio-cervical decompression; Dural peeling; Complications; CCD; MRI; CSF; DPe; CM-I; Duraplasty; Chiari malformation type I; DP
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.093

Chiari malformation type I is typified by the downward herniation of the cerebellar tonsils through the foramen magnum, which can impede cerebrospinal fluid circulation and may lead to syringomyelia. The usual symptoms of this condition are neck pain and posterior headaches on Valsalva maneuver. Different surgical procedures have been described for cranio-cervical decompression (CCD), without a consensus being reached about the best suited technique. The primary end point of this study was to compare efficacy and complications rate of CCD using dural peeling (DPe) versus duraplasty (DP). The secondary end point was to find predictive factors of success of DPe. Twenty-eight consecutive patients with Chiari malformation type I (12 women and 16 men) requiring CCD were enrolled at our institution between August 2011 and November 2015. Ten patients (35.7%) underwent DP, and 18 (64.3%) DPe. A standardized magnetic resonance imaging protocol was performed before and at least 3 months after surgery. Symptomatic outcome was evaluated at the last follow-up visit. Overall complications were more frequent in the DP (4 patients, 70%) group than in the DPe (none) group (P <0.05). All patients in the DP group improved clinically but only 12 patients (66.7%) in the DPe group (P = 0.1). Morphologic evolution at magnetic resonance imaging was similar in both groups. A moderate trend for changes in cerebellar tonsil conformation was shown in patients with clinical improvement (P = 0.07). Predictive factors of clinical improvement after DPe cannot be identified. CCD with DPe was less risky than with DP but had a lower responsive rate (66.7% vs. 100). Larger studies are therefore warranted to assess predictive factors of success of CCD with DPe. •Minimally invasive craniocervical decompression.•Potentially low or very low rate of complication with a significant rate of improvement.•Favor the participation of the patient in the decision as to the strategy.•Stimulate research for predictive factors of response to dura peeling.