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Surgical Results from Chiari Decompression: Comparing Duroplasty versus Dural Splitting Techinques. John A. Jane, Jr., M.D. Associate Professor of Neurosurgery and Pediatrics Director of Pediatric Neurosurgery University of Virginia Health System. Disclosures. None. Surgical Technique. - PowerPoint PPT Presentation
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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
Disclosures
• None
Surgical Technique• Bone removal:
– Posterior fossa decompression aka suboccipital craniectomy aka foramen magnum decompression
– C1 laminectomy, sometimes C2 and/or C3
Dural splitting• The spinal dura only
has one layer• “Dural splitting”
over the spine is not really splitting two layers
Surgical Technique
• Decompression (bone removal) alone
• Dural splitting– Use of intraoperative
ultrasound– Type of splitting
• Creation and removal of an outer layer
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
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
PFD with dural splitting
PFD with dural splitting
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
Complications• Original
surgery: PFD with division of adhesions and continuous sutured duraplasty
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
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%)
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
Thank you!
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