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Outcomes of dura-splitting technique compared to conventional duraplasty technique in the treatment of adult Chiari I malformation: a systematic review and meta-analysis

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Abstract

Chiari malformation type I is a developmental abnormality with an array of surgical techniques introduced for the management of it. The most common technique is foramen magnum decompression with duraplasty. Dura-splitting technique as one of the non-dura-opening techniques is a less known procedure that spares the internal layer of the dura and can theoretically result in fewer complications compared to duraplasty. So, we performed a review of literature and meta-analysis on different clinical and radiological aspects of this technique and compared its outcomes to duraplasty. MOOSE guidelines were followed. A systematic search of three databases based on predefined search strategy and inclusion/exclusion criteria was performed. After quality assessment and data extraction by two authors, summarized data were presented in form of tables, and meta-analysis results were illustrated in forest plots. A review of 10 included studies consisting of 370 patients revealed significantly shorter operation duration and less intraoperative blood loss in the dura-splitting technique compared to duraplasty. Interestingly, there was no significant difference between these two techniques in terms of clinical and radiological outcomes. Overall complication rate and incidence of CSF-related complications or infections were significantly in favor of the dura-splitting technique. Dura-splitting technique can be considered as a safe and effective surgical procedure for Chiari I malformation with comparable outcomes and fewer complications compared to duraplasty, although this interpretation is derived from retrospective observational studies and lack of a prospective clinical trial is evident.

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Authors and Affiliations

  1. Akbar Children Hospital, Neurosurgery Department, Mashhad University of Medical Sciences, Neurosurgery department office, 1st floor, Ghaem hospital, Ahmadabad Blvd., P.O. Box: 9176699199, Mashhad, Iran

    Amin Tavallaii & Ehsan Keykhosravi

  2. Neurosurgery Department, Mashhad University of Medical Sciences, Mashhad, Iran

    Hamid Rezaee, Mohammad Ali Abouei Mehrizi & Ahmad Ghorbanpour

  3. Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran

    Ali Shahriari

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  1. Amin Tavallaii
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Correspondence to Amin Tavallaii.

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This is a systematic review of available data and there is no human participant or animal directly or indirectly involved in this study.

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Because systematic reviews do not present individual data that can disclose patients’ identity, informed consent acquisition is not applicable. On the other hand, because systematic reviews use publicly available data for interpretation of results and do not include any interventions, institutional ethics approval was not obtained. But all relevant aspects of ethics in the research were considered and followed throughout the study.

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Tavallaii, A., Keykhosravi, E., Rezaee, H. et al. Outcomes of dura-splitting technique compared to conventional duraplasty technique in the treatment of adult Chiari I malformation: a systematic review and meta-analysis. Neurosurg Rev 44, 1313–1329 (2021). https://doi.org/10.1007/s10143-020-01334-y

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