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 Scopus citations

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
Publication statusPublished - Jun 2013

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Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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