Comparision of results between two different techniques of cranio-cervical decompression in patients with Chiari I malformation.
OBJECTIVE
A variety of approaches are employed for treatment of Chiari I malformation. They differ in extent of cranio-c ervical decompression. A technique based on arachnoid preservation and duroplasty was introduced in our department in 2001. The aim of the study is to compare between the previous and the present technique.


METHODS
Retrospective analysis of 38 patients with Chiari I malformation treated between 1998 and 2004 was performed. The previous technique including arach- noid incision, coagulation of cerebellar tonsils, and fourth ventricle exploration without duroplasty was used to treat 21 patients (group 1). A further 17 patients were treated with the present technique consisting of arachnoid preservation and duroplasty (group 2). Complication rates as well as early and late results of treatment were evaluated. Karnofsky (KPS), Rankin (RS) and Bidziński (BS) scales were used for evaluation of results.


RESULTS
Post-operative complications were detected in 9 patients in group 1 (43%). They included liquorrhoea (5 cases), meningitis (1 case), and symptoms progression (3 cases). There were no surgical complications in group 2 (p = 0.002). Neurological improvement in the early period (until discharge from hospital) occurred in 10 (48%) patients in group 1 and in 13 (76%) in group 2 (p = NS). Further improvement or lack of symptoms progression was found in 58% in group 1 and 82% in group 2 (p = NS). Assessment in KPS, RS and BS showed slightly better results of group 2 but the difference was statistically insignificant.


CONCLUSIONS
Results of both techniques are comparable. The risk of post-operative complications after extra-arachnoid cranio-cervical decompression with duroplasty is, however, significantly lower.
Kunert
Przemysław
P
Katedra i Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, ul. Banacha 1a, 02-097 Warszawa. pkunert@wp.pl
Janowski
Mirosław
M
Zakrzewska
Agnieszka
A
Marchel
Andrzej
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult