title: Posterior fossa decompression with duraplasty in Chiari-1 malformations.
abstract: OBJECTIVE
  To evaluate the symptomatic outcome after PFD (Posterior Fossa Decompression) with duraplasty in Chiari-1 malformations.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Department of Neurosurgery, JPMC, Karachi, from July 2008 to September 2012.
  
  
  METHODS
  This included 21 patients of Chiari 1 malformations admitted in department through OPD with clinical features of headache, neck pain, numbness, neurological deficit, and syringomyelia. Diagnosis was confirmed by MRI. PFD followed by C1 laminectomy with duraplasty was done in all cases and symptomatic outcome was assessed in follow-up clinic.
  
  
  RESULTS
  Among 21 patients, 13 were females and 8 were males. Age ranged from 18 to 40 years. All the patients had neck pain and numbness in hands. Only 3 patients had weakness of all four limbs and 12 with weakness of hands. Symptoms evolved over a mean of 12 months. Syringomyelia was present in all cases. All patients underwent posterior fossa decompression with duraplasty with an additional C1 laminectomy and in 2 cases C2 laminectomy was done. Syringo-subarachnoid shunt was placed in one patient and ventriculo-peritoneal shunt was placed in 2 patients. Pain was relieved in all cases. Weakness was improved in all cases and numbness was improved in 19 cases. Syringomyelia was improved in all cases. Postoperative complications included CSF leak in 2 patients and wound infection in one patient. However, there was no mortality.
  
  
  CONCLUSIONS
  Posterior fossa decompression with duraplasty is the best treatment option for Chiari-1 malformations because of symptomatic improvement and less chances of complications.
authors.affiliation: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Lal
authors.initials: L
authors.lastname: Rehman
authors.affiliation: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Hamid
authors.initials: H
authors.lastname: Akbar
authors.affiliation: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Iram
authors.initials: I
authors.lastname: Bokhari
authors.affiliation: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Asghar Khan
authors.initials: AK
authors.lastname: Babar
authors.affiliation: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: A Sattar
authors.initials: AS
authors.lastname: M Hashim
authors.affiliation: Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Safdar Hussain
authors.initials: SH
authors.lastname: Arain
mesh_terms: D000293:Adolescent; D000328:Adult; D001139:Arnold-Chiari Malformation / Q000175:diagnosis / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D055815:Young Adult