• Michelle Feinberg, Tiffani DeFreitas, John S Myseros, Suresh N Magge, Chima Oluigbo, and Robert F Keating.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:201.

IntroductionControversy continues surrounding the optimal surgical approach to Chiari decompression and whether the dura needs to be opened. Assessment of long-term outcomes looking specifically at failure rates, and associated factors, for bone-only decompression vs duraplasty was undertaken.MethodsRetrospective review of patients undergoing decompression from 1996 to 2014 (18 years) at CNMC identified patients requiring additional Chiari decompression for worsening symptoms or persistent syringomyelia (IRB #Pro268). Preoperative symptoms, imaging studies, operative reports, and postoperative follow-up were available for all included patients.ResultsNineteen of 195 (9.74%) patients were identified requiring additional Chiari decompression. Average age at initial surgery was 9.4 years (1-17) and 10.3 years (3-20) for second surgery. Length of time between surgeries was 2.8 years (4 months-8 years) with follow-up 47 months (1-224). Patients undergoing bone-only decompression demonstrated 10/70 (14%) need for additional Chiari surgery, whereas 9/125 (7%) of patients having duraplasty required a second operation (OR 2.14, CI 0.82-5.571, P = .11). The syrinx cohort demonstrated a similar failure rate (OR 2.04, CI 0.577-7.21, P = .26). Analysis of holocord syrinxes was also not significant (OR 2, CI 0.43-9.2, P = .36). Factors contributing to reoperation for both surgical cohorts found inadequate bony decompression in 2/19, bone regrowth in 3/19, and arachnoid scarring at 4th ventricular outflow in 17/19 patients. Ten of 19 (53%) required placement of 4th ventricular stent. Six of 19 (32%) had craniofacial comorbidity. Complications were seen in 2/70 (3%) for bone-only decompression vs 26% (CSF leak in 14; pseudomeningocele in 26; meningitis in 4, P < .001).ConclusionComparison of Chiari failures does not appear to differentiate between open and closed decompression. The most common cause of failure was the presence of arachnoid scaring at the 4th ventricular outflow in both surgical cohorts. Craniofacial comorbidity increased the likelihood of surgical failure, especially when hydrodynamic issues were involved.

24 keywords...

hide…