Abstract
Type I Chiari malformation is a developmental anomaly with various proposed surgical
techniques for its management. The dura-splitting technique is a less invasive approach
and involves the resection of the outer layer of the dura while sparing the internal
layer. While this less-known approach may minimize the complication rates, there are
concerns about its efficacy and outcome. Therefore, we have performed a systematic
review and meta-analysis of available data on clinical and radiological outcomes of
this technique in the pediatric population and compared them to the foramen magnum
decompression and duraplasty technique.
We have followed the Meta-analysis Of Observational Studies in Epidemiology guidelines
in this review. Based on our predefined search strategy, we performed a systematic
database search. Subsequently, the article screening process was done based on defined
inclusion/exclusion criteria. Following the quality assessment of included studies,
two authors performed data extraction. Finally, the extracted data were summarized
and presented in form of tables. Forest plots were used to demonstrate the results
of the meta-analysis.
A review of 8 included studies consisting of 615 patients revealed the significant
advantage of the dura-splitting technique in terms of shorter operation duration and
hospital stay. The recurrence rate and clinical and radiological outcomes were almost
similar between the two surgical techniques. Complication rates were significantly
lower in the dura-splitting technique.
Dura-splitting can be an effective and safe approach for the management of pediatric
Chiari I malformation. However, these results are mostly extracted from observational
studies and future randomized controlled trials are recommended.
Keywords Chiari malformation type I - dura-splitting - duraplasty - outcome - pediatric
