title: Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization.
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).
  
  
  CONCLUSIONS
  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.
authors: Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
authors: Zachary N
authors: ZN
authors: Litvack
authors: Rebecca A
authors: RA
authors: Lindsay
authors: Nathan R
authors: NR
authors: Selden
mesh_terms: D001139:Arnold-Chiari Malformation / Q000601:surgery*; D002648:Child; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D019635:Neurosurgical Procedures / Q000191:economics / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome