MBBS Candidate BGS Global Institute of Medical Sciences Bangalore, Karnataka, India
Introduction: Type I Arnold-Chiari Malformation is consisting of herniation of the cerebellar tonsils into the foramen magnum, thus crowding the craniocervical junction is the most common of all the CMIs. In case of serious clinical significance, surgery is the standard approach, with many techniques yielding satisfactory results.
Methods: Keyword search of “Chiari malformation I”, “surgical techniques”, “posterior fossa decompression with duraplasty” (PFDD), and “dura splitting decompression” (DSD) was conducted in the PubMed, Google Scholar, and Cochrane databases. Inclusion criteria included the diagnosis of CMI confirmed by MRI, randomized or non-randomized controlled trials, and comparison between different therapeutic approaches. Following this, 13 unique studies which met the inclusion criteria were reviewed.
Results: PFDD, creating additional space for the cerebrospinal fluid to circulate is the standard surgical approach. DSD is preferred by some surgeons because it does not involve entering the intradural space. There is no significant difference in clinical and syringomyelia improvement, wound infection, or reoperation need between the two approaches. On the other hand, the significantly decreased operation time, hospitalization period, and overall postoperative complications mainly concerning CSF leak, aseptic meningitis, and pseudomeningocele occurrence in DSD are advantageous.
Conclusion : Although PFDD has clinical and radiological improvement outcomes comparable to DSD, the latter holds certain advantages that are not to be neglected. Further studies on this topic are necessary to better understand the implications of all surgical methods and also find novel therapeutic options for symptomatic CMI patients.
