Journal article
Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium
Journal of neurosurgery. Pediatrics, Vol.30(1), pp.39-51
2022
DOI: 10.3171/2022.2.PEDS21446
PMID: 35426814
Abstract
The aim of this study was to determine differences in complications and outcomes between posterior fossa decompression with duraplasty (PFDD) and without duraplasty (PFD) for the treatment of pediatric Chiari malformation type I (CM1) and syringomyelia (SM).
The authors used retrospective and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM1-SM who received PFD or PFDD and had at least 1 year of follow-up data. Preoperative, treatment, and postoperative characteristics were recorded and compared between groups.
A total of 692 patients met the inclusion criteria for this database study. PFD was performed in 117 (16.9%) and PFDD in 575 (83.1%) patients. The mean age at surgery was 9.86 years, and the mean follow-up time was 2.73 years. There were no significant differences in presenting signs or symptoms between groups, although the preoperative syrinx size was smaller in the PFD group. The PFD group had a shorter mean operating room time (p < 0.0001), fewer patients with > 50 mL of blood loss (p = 0.04), and shorter hospital stays (p = 0.0001). There were 4 intraoperative complications, all within the PFDD group (0.7%, p > 0.99). Patients undergoing PFDD had a 6-month complication rate of 24.3%, compared with 13.7% in the PFD group (p = 0.01). There were no differences between groups for postoperative complications beyond 6 months (p = 0.33). PFD patients were more likely to require revision surgery (17.9% vs 8.3%, p = 0.002). PFDD was associated with greater improvements in headaches (89.6% vs 80.8%, p = 0.04) and back pain (86.5% vs 59.1%, p = 0.01). There were no differences between groups for improvement in neurological examination findings. PFDD was associated with greater reduction in anteroposterior syrinx size (43.7% vs 26.9%, p = 0.0001) and syrinx length (18.9% vs 5.6%, p = 0.04) compared with PFD.
PFD was associated with reduced operative time and blood loss, shorter hospital stays, and fewer postoperative complications within 6 months. However, PFDD was associated with better symptom improvement and reduction in syrinx size and lower rates of revision decompression. The two surgeries have low intraoperative complication rates and comparable complication rates beyond 6 months.
Details
- Title: Subtitle
- Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium
- Creators
- S Hassan A Akbari - HersheyAlexander T Yahanda - 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MOLaurie L Ackerman - Indiana UniversityP David Adelson - Barrow Neurological InstituteRaheel Ahmed - University of Wisconsin–MadisonGregory W Albert - Arkansas Children's HospitalPhilipp R Aldana - University of FloridaTord D Alden - Lurie Children's HospitalRichard C E Anderson - Morgan Stanley Children's HospitalDavid F Bauer - 10Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TXTammy Bethel-Anderson - 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MOKarin Bierbrauer - 36Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OHDouglas L Brockmeyer - Primary Children's HospitalJoshua J Chern - Children's Healthcare of AtlantaDaniel E Couture - Wake Forest UniversityDavid J Daniels - 14Department of Neurosurgery, Mayo Clinic, Rochester, MNBrian J Dlouhy - University of IowaSusan R Durham - Children's Hospital of Los AngelesRichard G Ellenbogen - Seattle Children's HospitalRamin Eskandari - Medical University of South CarolinaHerbert E Fuchs - Duke University School of MedicineGerald A Grant - Lucile Packard Children's HospitalPatrick C Graupman - 21Division of Pediatric Neurosurgery, Gillette Children's Hospital, St. Paul, MNStephanie Greene - University of Pittsburgh Medical CenterJeffrey P Greenfield - NewYork–Presbyterian HospitalNaina L Gross - University of OklahomaDaniel J Guillaume - University of Minnesota Medical SchoolTodd C Hankinson - Children's Hospital ColoradoGregory G Heuer - Children's Hospital of PhiladelphiaMark Iantosca - HersheyBermans J Iskandar - University of Wisconsin–MadisonEric M Jackson - Johns Hopkins University School of MedicineGeorge I Jallo - Johns Hopkins All Children's HospitalJames M Johnston - University of Alabama at BirminghamBruce A Kaufman - Medical College of WisconsinRobert F Keating - 32Department of Neurosurgery, Children's National Medical Center, Washington, DCNicklaus R Khan - University of Tennessee Health Science CenterMark D Krieger - Children's Hospital of Los AngelesJeffrey R Leonard - Nationwide Children's HospitalCormac O Maher - University of MichiganFrancesco T Mangano - 36Division of Pediatric Neurosurgery, Cincinnati Children's Medical Center, Cincinnati, OHJ Gordon McComb - Children's Hospital of Los AngelesSean D McEvoy - 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MOThanda Meehan - 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MOArnold H Menezes - University of IowaMichael S Muhlbauer - University of Tennessee Health Science CenterBrent R O'Neill - Children's Hospital ColoradoGreg Olavarria - Arnold Palmer Hospital for ChildrenJohn Ragheb - University of MiamiNathan R Selden - Oregon Health & Science UniversityManish N Shah - 40Division of Pediatric Neurosurgery, McGovern Medical School, Houston, TXChevis N Shannon - Vanderbilt UniversityJoshua S Shimony - 42Department of Radiology, Washington University School of Medicine, St. Louis, MOMatthew D Smyth - Johns Hopkins All Children's HospitalScellig S D Stone - Boston Children's HospitalJennifer M Strahle - 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MOMandeep S Tamber - University of British ColumbiaJames C Torner - University of IowaGerald F Tuite - Johns Hopkins All Children's HospitalElizabeth C Tyler-Kabara - The University of Texas at AustinScott D Wait - 46Carolina Neurosurgery & Spine Associates, Charlotte, NCJohn C Wellons - Vanderbilt UniversityWilliam E Whitehead - 10Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TXTae Sung Park - 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MODavid D Limbrick - 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery. Pediatrics, Vol.30(1), pp.39-51
- DOI
- 10.3171/2022.2.PEDS21446
- PMID
- 35426814
- NLM abbreviation
- J Neurosurg Pediatr
- eISSN
- 1933-0715
- Language
- English
- Electronic publication date
- 04/15/2022
- Date published
- 2022
- Academic Unit
- Neurology; Stead Family Department of Pediatrics; Epidemiology; Iowa Neuroscience Institute; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984242657302771
Metrics
27 Record Views