TY - JOUR
T1 - Dura splitting decompression for Chiari I malformation in pediatric patients
T2 - Clinical outcomes, healthcare costs, and resource utilization
AU - Litvack, Zachary N.
AU - Lindsay, Rebecca A.
AU - Selden, Nathan R.
PY - 2013/6
Y1 - 2013/6
N2 - Background: Dural splitting decompression may be an effective and safe treatment for Chiari I malformation. Objective: To compare clinical outcomes, complications, and resource utilization for patients undergoing Chiari I decompression with or without duraplasty. Methods: Between 2000 and 2009, the senior author performed 113 Chiari I decompression operations with dural splitting or duraplasty in children less than 18 years of age; 110 were included in a retrospective cohort analysis of safety, efficacy, and treatment cost. Patients without significant syringomyelia underwent dural splitting decompression, and patients with syringomyelia underwent duraplasty. Results: Sixty-three patients without significant syringomyelia (57%) underwent dural splitting decompression. They were significantly younger than patients undergoing duraplasty (8.3 ± 4.9 years vs 10.4 ± 4.4 years; P < .05). Headaches improved or resolved in most patients in both groups (90.5% vs 93.6%; P = .59). Dysphagia, long tract signs, cranial nerve, and bulbar symptoms also improved similarly in both groups. Three duraplasty patients were treated medically for aseptic meningitis; one underwent reoperation for a symptomatic pseudomeningocele. No patient undergoing dural splitting decompression experienced a cerebrospinal fluid-related complication. Extradural decompression required less operative time than duraplasty (105.5 vs 168.9 minutes, P < .001), a shorter length of stay (2.4 vs 2.8 days, P = .011), and lower total cost for the primary hospitalization ($26 837 vs $29 862, P = .015). Conclusion: In this retrospective cohort study, dural splitting decompression was equally effective, safer, and lower cost for treatment of Chiari I malformation without syringomyelia. A multicenter trial with groups balanced for the presence of syringomyelia is necessary to determine whether these results are generalizable.
AB - Background: Dural splitting decompression may be an effective and safe treatment for Chiari I malformation. Objective: To compare clinical outcomes, complications, and resource utilization for patients undergoing Chiari I decompression with or without duraplasty. Methods: Between 2000 and 2009, the senior author performed 113 Chiari I decompression operations with dural splitting or duraplasty in children less than 18 years of age; 110 were included in a retrospective cohort analysis of safety, efficacy, and treatment cost. Patients without significant syringomyelia underwent dural splitting decompression, and patients with syringomyelia underwent duraplasty. Results: Sixty-three patients without significant syringomyelia (57%) underwent dural splitting decompression. They were significantly younger than patients undergoing duraplasty (8.3 ± 4.9 years vs 10.4 ± 4.4 years; P < .05). Headaches improved or resolved in most patients in both groups (90.5% vs 93.6%; P = .59). Dysphagia, long tract signs, cranial nerve, and bulbar symptoms also improved similarly in both groups. Three duraplasty patients were treated medically for aseptic meningitis; one underwent reoperation for a symptomatic pseudomeningocele. No patient undergoing dural splitting decompression experienced a cerebrospinal fluid-related complication. Extradural decompression required less operative time than duraplasty (105.5 vs 168.9 minutes, P < .001), a shorter length of stay (2.4 vs 2.8 days, P = .011), and lower total cost for the primary hospitalization ($26 837 vs $29 862, P = .015). Conclusion: In this retrospective cohort study, dural splitting decompression was equally effective, safer, and lower cost for treatment of Chiari I malformation without syringomyelia. A multicenter trial with groups balanced for the presence of syringomyelia is necessary to determine whether these results are generalizable.
KW - Chiari decompression
KW - Chiari malformation
KW - Cost-benefit
KW - Extradural decompression
UR - http://www.scopus.com/inward/record.url?scp=84878857556&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84878857556&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e31828ca1ed
DO - 10.1227/NEU.0b013e31828ca1ed
M3 - Article
C2 - 23426152
AN - SCOPUS:84878857556
SN - 0148-396X
VL - 72
SP - 922
EP - 928
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -