Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation.
OBJECTIVE
Few studies are available that directly compare dural opening with and without additional intradural maneuvers. Therefore, the current review analyzed the available literature regarding this topic.


METHODS
An Ovid MEDLINE search was completed using each of the terms "Chiari malformation," "syringomyelia," "syrinx," "syringohydromyelia" in combination with "child" or "pediatric." Publications were considered relevant if they reported the results of posterior fossa decompression without dural opening (PFD) to posterior fossa decompression with duraplasty (PFDD). The included studies were divided into three categories based upon the surgical techniques studied. The first group of papers included works that directly compared PFD to PFDD. The second group included studies in which all patients were treated with PFD. The third group included studies in which all patients were treated with PFDD. Three outcome parameters were assessed: (1) improvement of clinical signs/symptoms, (2) syrinx resolution, and (3) scoliosis progression.


RESULTS
At this time, there is no level I or IIa evidence comparing PFD with PFDD. The notions that PFDD has a lower rate of reoperation and that PFD has a lower rate of cerebrospinal fluid-related complications are both based on IIb/B evidence.


CONCLUSIONS
Prospective randomized trials are necessary for definitive comments regarding the success of PFD and PFDD.
Hankinson
Todd
T
Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South, Birmingham, AL 35233, USA.
Tubbs
R Shane
RS
Wellons
John C
JC
D001139:Arnold-Chiari Malformation / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D004388:Dura Mater / Q000601:surgery*; D019317:Evidence-Based Medicine; D006801:Humans; D019635:Neurosurgical Procedures; D019651:Plastic Surgery Procedures