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.
Keywords
Chiari type I malformation - duraplasty - dural splitting - clinical improvement -
radiologic regression
