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Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques

Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques. John A. Jane, Jr., M.D. Associate Professor of Neurosurgery and Pediatrics Director of Pediatric Neurosurgery University of Virginia Health System. Disclosures. None. Surgical Technique.

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Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques

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  1. Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques John A. Jane, Jr., M.D. Associate Professor of Neurosurgery and Pediatrics Director of Pediatric Neurosurgery University of Virginia Health System

  2. Disclosures • None

  3. Surgical Technique • Bone removal: • Posterior fossa decompression aka suboccipital craniectomy aka foramen magnum decompression • C1 laminectomy, sometimes C2 and/or C3

  4. Dural splitting • The spinal dura only has one layer • “Dural splitting” over the spine is not really splitting two layers

  5. Surgical Technique • Decompression (bone removal) alone • Dural splitting • Use of intraoperative ultrasound • Type of splitting • Creation and removal of an outer layer

  6. Surgical Series • 2006-2009, Age<18 • N=16 • Posterior fossa decompression and duraplasty=8 • 6 syringomyelia • Posterior fossa decompression alone=8 • 6 syringomyelia • Both groups similar in terms of age, symptoms, degree of tonsillar herniation, and syringomyelia

  7. Outcomes • Syringes • Significantly decreased or resolved in 5 of 6 patients in each group • Tonsillar regression • PFD alone: 6 of 7 • PFD plus duraplasty: 5 of 7

  8. PFD with dural splitting

  9. PFD with dural splitting

  10. Complications • Postoperative nausea • PFD alone: 0/8 • PFD with duraplasty: 5/8 • Higher rate of complications associated with PFD with duraplasty • Meningitis, Reoperation for CSF leak, Symptomatic pseudomeningocele

  11. Complications • Original surgery: PFD with division of adhesions and continuous sutured duraplasty

  12. Complications • Chemical meningitis: repeat PFD with removal of dural graft and placement of pericranial graft • Pseudomeningocele with CSF leak requiring repeat closure of incision • Continued pseudomeningocele treated with a ventriculoperitoneal shunt

  13. Recent reports • Decompression alone procedures were shorter, had shorter hospital stays, and less pain and nausea • However, PFD alone was associated with a higher incidence of symptomatic recurrence and need for dural opening (12.5% versus 3.1%)

  14. Conclusions • Posterior fossa decompression with dural splitting is better tolerated and associated with fewer complications than PFD with duraplasty • Posterior fossa decompression with dural splitting can provide effective treatment of syringomyelia in most patients

  15. Thank you! Questions?

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