title: Effect of symptomatic pseudomeningocele on improvement in pain, disability, and quality of life following suboccipital decompression for adult Chiari malformation type I.
abstract: OBJECTIVE
  Suboccipital decompression is a common procedure for patients with Chiari malformation Type I (CMI). Published studies have reported complication rates ranging from 3% to 40%, with pseudomeningocele being one of the most common complications. To date, there are no studies assessing the effect of this complication on long-term outcome. Therefore, the authors set out to assess the effect of symptomatic pseudomeningocele on patient outcomes following suboccipital decompression for CM-I.
  
  
  METHODS
  The study comprised 50 adult patients with CM-I who underwent suboccipital craniectomy and C-1 laminectomy with or without duraplasty. Clinical presentation, radiological studies, operative variables, and complications were assessed for each case. Baseline and 1-year postoperative patient-reported outcomes were assessed to determine improvement in pain, disability, and quality of life. The extent of improvement was compared for patients with and without development of a postoperative symptomatic pseudomeningocele.
  
  
  RESULTS
  A symptomatic pseudomeningocele developed postoperatively in 9 patients (18%). There was no difference with regard to clinical, radiological, or operative variables for patients with or without a postoperative pseudomeningocele. Patients without a pseudomeningocele had significant improvement in all 9 patient-reported outcome measures assessed. On the other hand, patients with pseudomeningocele only had significant improvement in headache (as measured on the Numeric Rating Scale) and headache-related disability (as measured on the Headache Disability Index) but no improvement in quality of life. Twenty-nine (71%) of 41 patients without a pseudomeningocele reported improvement in health status postoperatively compared with only 3 (33%) of 9 patients with a postoperative pseudomeningocele (p = 0.05).
  
  
  CONCLUSIONS
  Surgical management of CM-I in adults provides significant and sustained improvement in pain, disability, general health, and quality of life. Development of a postoperative symptomatic pseudomeningocele has lingering effects at 1 year, and it significantly diminishes the overall benefit of suboccipital decompression for CM-related symptoms. Further research is needed to accurately predict which patients may benefit from decompression alone without duraplasty.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Saniya S
authors.initials: SS
authors.lastname: Godil
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Mendenhall
authors.forename: Noel B
authors.initials: NB
authors.lastname: Tulipan
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008588:Meningocele / Q000209:etiology; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009777:Occipital Bone / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D016896:Treatment Outcome