Dura splitting decompression for Chiari I malformation in pediatric patients: Clinical outcomes, healthcare costs, and resource utilization

Zachary N. Litvack, Rebecca A. Lindsay, Nathan Selden

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)922-928
Number of pages7
JournalNeurosurgery
Volume72
Issue number6
DOIs
StatePublished - Jun 2013

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Decompression
Health Care Costs
Syringomyelia
Pediatrics
Cohort Studies
Aseptic Meningitis
Cranial Nerves
Operative Time
Deglutition Disorders
Reoperation
Multicenter Studies
Headache
Cerebrospinal Fluid
Length of Stay
Hospitalization
Retrospective Studies
Safety
Costs and Cost Analysis

Keywords

  • Chiari decompression
  • Chiari malformation
  • Cost-benefit
  • Extradural decompression

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Dura splitting decompression for Chiari I malformation in pediatric patients : Clinical outcomes, healthcare costs, and resource utilization. / Litvack, Zachary N.; Lindsay, Rebecca A.; Selden, Nathan.

In: Neurosurgery, Vol. 72, No. 6, 06.2013, p. 922-928.

Research output: Contribution to journalArticle

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