Y-Shaped Versus Linear Duraplasty Technique in Posterior Fossa Decompression for Treatment of Chiari Malformation Type I: A Propensity Score-Matched Comparative Study.
Posterior fossa decompression, with or without duraplasty, is effective for the treatment of pediatric patients with symptomatic Chiari malformation type I (CM-I). The aim of this study was to compare effectiveness and clinical outcomes of Y-shaped vs linear techniques during posterior fossa decompression with duraplasty (PFDD) for CM-I patients. Retrospective review of data for pediatric patients (≤21 years old) with CM-I and surgically managed with PFDD with or without C1 laminectomy was performed. Clinical characteristics, including presence of a syrinx and presentation, were recorded. Patients were dichotomized into 2 propensity score-matched (PSM) groups based on whether a Y-shaped or linear dural incision was used. All statistical tests were 2-tailed, and a P-value <.05 was significant. A total of 228 patients met the inclusion criteria, with 124 undergoing linear and 104 undergoing Y-shaped dural incision. After PSM, each group had 66 patients who were well-matched for age, sex, presentation, and extent of tonsillar herniation. Patients in the linear incision group had significantly lower estimated blood loss (Y-shaped: 66.5 ± 75.8 mL vs linear: 33.9 ± 18.9 mL, P < .01). Although the rate of complete symptom resolution was higher in the linear group before PSM (Y-shaped: 28.8% vs linear: 57.3%, P < .001), this difference was not significant after PSM (Y-shaped: 31.8% vs linear: 47%, P = .205). Similarly, fewer repeat decompression procedures were needed in the linear group before PSM (Y-shaped: 13.5% vs linear: 0.8%, P < .001) but not after (Y-shaped: 10.6% vs linear: 1.5%, P = .062). Linear and Y-shaped dural incisions are safe and effective for PFDD in pediatric CM-I patients. Linear incisions were associated with reduced blood loss, although neither group had a clinically significant blood loss and overall clinical outcomes were comparable after PSM. These findings can help guide surgical decision-making for CM-I. Further studies are warranted to validate these results and explore the influence of surgeon experience and preference on the associated outcomes.
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