Dura-splitting decompression of the craniocervical junction: Reduced operative time, hospital stay, and cost with equivalent early outcome

Farhad M. Limonadi, Nathan R. Selden

Research output: Contribution to journalArticlepeer-review

81 Scopus citations

Abstract

Object. The choice of surgical technique for decompressive surgery in patients with Chiari I malformation is controversial. Good preliminary postoperative outcomes have been achieved in patients with Chiari I malformation (without syringomyelia) after using a dura-splitting technique. The authors evaluated safety, resource use, and early outcome after this surgery in patients without syringomyelia and compared the findings associated with duraplasty in patients with syringomyelia. Methods. A prospective series of 24 patients with Chiari I malformation (12 with a syrinx) underwent decompres-sion of the craniocervical junction (CCJ). An allograft-augmented duraplasty was performed in patients with syringomyelia. Intraoperative ultrasonography confirmed adequate tonsillar decompression after lysis of the periosteal bands at the foramen magnum and C-1 arch as well as partial resection of the outer leaf of the dura in patients without syringomyelia. Patients in each group were of similar mean age (syringomyelia 10.8 years and no syringomyelia 7.6 years old; p = 0.07) and functional status. The mean follow-up period was 15.3 months (range 3-30 months). Durasplitting decompression required significantly less mean operative time (99 minutes compared with 169 minutes, respectively; p < 0.001), total operating room time (166 minutes compared with 249 minutes, respectively; p < 0.001), duration of hospitalization (3 days compared with 3.75 days, respectively; p < 0.05), perioperative charges ($3615 compared with $5538, respectively; p < 0.001), and overall hospital charges ($7705 compared with $9759, respectively; p < 0.001) than the duraplasty. Mean clinical outcome scores were similar (syringomyelia 1.53 of 2; no syringomyelia 1.67 of 2; not statistically significant). Conclusions. Dura-splitting CCJ decompression in pediatric patients with Chiari I malformation and without syringomyelia is safe, provides good early clinical results, and significantly reduces resource use. A randomized controlled trial of dura-splitting decompression in a uniform population of patients with Chiari I malformation is indicated.

Original languageEnglish (US)
Pages (from-to)184-188
Number of pages5
JournalJournal of neurosurgery
Volume101
Issue numberSUPPL. 2
DOIs
StatePublished - Nov 2004

Keywords

  • Chiari malformation
  • Craniocervical spine
  • Decompression
  • Dura mater
  • Duraplasty
  • Pediatric neurosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Dura-splitting decompression of the craniocervical junction: Reduced operative time, hospital stay, and cost with equivalent early outcome'. Together they form a unique fingerprint.

Cite this