Efficacy of posterior fossa decompression with duraplasty for patients with Chiari malformation type I: a systematic review and meta-analysis.

Efficacy of posterior fossa decompression with duraplasty for patients with Chiari malformation type I: a systematic review and meta-analysis.

World Neurosurg. 2018 Feb 23;:

Authors: Chai Z, Xue X, Fan H, Sun L, Cai H, Ma Y, Ma C, Zhou R

Abstract
This study aimed to quantitatively assess and compare the effect and safety of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression (PFD) in treating patients with Chiari malformation type I (CM1). PubMed, Embase, and Cochrane Library were searched through May 2017. Fourteen cohort studies, involving a total of 3666 patients with CM1, were included. Studies were pooled, and the relative risk (RR) and its corresponding 95% confidence interval (CI) were calculated. The decrease in syringomyelia was better for patients in the PFDD group than for patients in the PFD group (RR=1.57, 95%CI=1.07-2.32, Pheterogeneity=0.042, I2=56.6%). The incidence of cerebrospinal fluid leak (RR=5.23, 95%CI=2.61-10.51, Pheterogeneity=0.830, I2=0%) and aseptic meningitis (RR=4.02, 95%CI=1.46-11.03, Pheterogeneity=0.960, I2=0%) significantly increased among patients in the PFDD group compared with those in the PFD group. On stratifying by age, a significantly reduced risk in the reoperation rate was observed in the adult group. However, the clinical improvement and the incidence of wound infection were not significantly different between the two groups. This study confirmed that the decrease in syringomyelia was better for patients treated with PFDD than for those treated with PFD alone. However, no significant difference was found in the clinical improvement and the reoperation rate between the two groups.

PMID: 29482005 [PubMed - as supplied by publisher]

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