surgical results from chiari decompression: comparing duroplasty versus dural splitting techinques...
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![Page 1: Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques John A. Jane, Jr., M.D. Associate Professor of Neurosurgery](https://reader037.vdocuments.net/reader037/viewer/2022110400/56649daa5503460f94a98037/html5/thumbnails/1.jpg)
Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques
John A. Jane, Jr., M.D.Associate Professor of Neurosurgery and
PediatricsDirector of Pediatric Neurosurgery
University of Virginia Health System
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Disclosures
• None
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Surgical Technique• Bone removal:
– Posterior fossa decompression aka suboccipital craniectomy aka foramen magnum decompression
– C1 laminectomy, sometimes C2 and/or C3
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Dural splitting• The spinal dura only
has one layer• “Dural splitting”
over the spine is not really splitting two layers
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Surgical Technique
• Decompression (bone removal) alone
• Dural splitting– Use of intraoperative
ultrasound– Type of splitting
• Creation and removal of an outer layer
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Surgical Series
• 2006-2009, Age<18• N=16
– Posterior fossa decompression and duraplasty=8• 6 syringomyelia
– Posterior fossa decompression alone=8• 6 syringomyelia
– Both groups similar in terms of age, symptoms, degree of tonsillar herniation, and syringomyelia
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Outcomes
• Syringes – Significantly decreased or resolved in 5 of 6 patients in
each group
• Tonsillar regression– PFD alone: 6 of 7– PFD plus duraplasty: 5 of 7
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PFD with dural splitting
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PFD with dural splitting
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Complications
• Postoperative nausea– PFD alone: 0/8– PFD with duraplasty: 5/8
• Higher rate of complications associated with PFD with duraplasty– Meningitis, Reoperation for CSF leak, Symptomatic
pseudomeningocele
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Complications• Original
surgery: PFD with division of adhesions and continuous sutured duraplasty
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Complications• Chemical meningitis: repeat PFD
with removal of dural graft and placement of pericranial graft
• Pseudomeningocele with CSF leak requiring repeat closure of incision
• Continued pseudomeningocele treated with a ventriculoperitoneal shunt
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Recent reports
• Decompression alone procedures were shorter, had shorter hospital stays, and less pain and nausea
• However, PFD alone was associated with a higher incidence of symptomatic recurrence and need for dural opening (12.5% versus 3.1%)
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Conclusions
• Posterior fossa decompression with dural splitting is better tolerated and associated with fewer complications than PFD with duraplasty
• Posterior fossa decompression with dural splitting can provide effective treatment of syringomyelia in most patients
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Thank you!
Questions?