Posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation

Child's Nervous System

Debate continues over whether adding duraplasty to bony decompression for Chiari I malformation patients increases symptomatic relief and improves syringomyelia resolution.  Lee et al. recently reported 24 months followup data on a retrospective cohort study with historical control of 65 consecutive children (under 18y) undergoing Chiari I decompression. No statistically significant differences in Chicago Chiari Outcome Scale (CCOS), syrinx resolution, or other complications were observed. Decompression alone (n=29) was associated with fewer CSF-related complications (19% vs. 0% p=0.014), shorter lengths of surgery and shorter hospital stays. Despite the limitations of its methodology, this study is the first comparison of balanced treatment groups and uses a validated clinical outcome score to support that Chiari I decompression may be as effective, with potentially lower complication rates, than decompression with duraplasty.

Brandon G. Rocque, MD MS
Birmingham, AL