Comparison of Foramen Magnum Decompression with and without Duraplasty in the Treatment of Adult Chiari Malformation Type I: A Meta-Analysis and Systematic Review.

AIM: To include new relevant findings in a systematic review to provide the first comparison of foramen magnum decompression with duraplasty (PFDD) and without duraplasty (PFD) in adult Chiari malformation Type I (CM-I).

MATERIAL AND

METHODS

We retrospectively searched Web of Science, PubMed, Embase and ClinicalTrials.gov to summarize all relevant published papers on adults. A systemic review was adopted to evaluate clinical or radiological improvement, surgical complications, and reoperation rates between the PFD and PFDD groups.

RESULTS

Nine papers containing information on 497 adult participants met the criteria. PFDD was related to a lower revision rate (RR=2.96, 95% CI: 1.34-6.51, p=0.007) but a higher complication rate (RR=0.35, 95% CI: 0.22-0.55, p < 0.00001). No significant difference was noted between PFD and PFDD in terms of overall symptom improvement (RR=0.93, 95% CI: 0.84-1.03, p=0.17) or syringomyelia reduction (RR=0.84, 95% CI: 0.63-1.12, p=0.24). No significant difference in symptom improvement was observed between patients with syringomyelia (RR=0.86, 95% CI: 0.69-1.08, p=0.20) and patients without syringomyelia (RR=0.94, 95% CI: 0.68-1.30, p=0.73).

CONCLUSION

This systematic review of observational studies reveals that PFDD may provide lower revision rates but pose a higher risk than PFD in the management of CM-I in adults. However, PFD is similar to PFDD in clinical and radiological improvements.