Authors : Raveesh Sunkara, Sai Kalyan S, Chandrasekhar Naidu, Naresh Reddy, Mohan Rao K, Rohan Prithviraj Patil
DOI : 10.18231/j.pjms.2023.074
Volume : 13
Issue : 2
Year : 2023
Page No : 386-390
Objectives: In Chiari malformation type I (CIM), the cerebellar tonsils and the medial parts of the inferior cerebellar lobules are displaced downward through the foramen magnum into the upper cervical spinal canal. The primary surgical treatment for the Chiari I malformation is foramen magnum decompression. This study was undertaken to assess the clinical outcome in terms of clinical symptoms improvement in patients with Chiari malformation type I treated with foramen magnum decompression with duraplasty vs. primary repair of dura.
Materials and Methods: A total of 32, 24 patients retrospectively and 8 cases prospectively were studied after being diagnosed and operated on for Chiari malformation type I. Patients with Chiari types II, III, and IV were not allowed to participate. Before and one year after surgery, a questionnaire was utilized to measure improvements in neck pain and impairment caused by it, head aches and disability caused by it, and overall health. The findings of both groups' questionnaires were analysed and compared.
Results: The third decade (34.38%) was the most prevalent age group for presentations, followed by the fourth decade (31.25 %). The ratio of males to females was 1.2:1. Sensory disturbances were the most frequent presenting symptom, found in 25 patients (78.13%), and followed by neck discomfort in 14 patients (43.75%). Leg weakness was the most frequent symptom, which was reported in 20 patients (62.50%). The foramen magnum decompression and duraplasty was done in 18 patients, whereas the foramen magnum decompression and primary repair was done in 14 patients. In the duraplasty group, there were greater problems. The Duraplasty group had an overall clinical improvement rate of 88.89%, while the non duraplasty group had a lower overall clinical improvement rate of 50%. Specific complaints such as neck discomfort improved at a comparable rate (88.89%) in the duraplasty group compared to the non-duraplasty group (80%).
Conclusions: Although foramen magnum decompression with duraplasty is preferable to foramen magnum decompression with primary repair, duraplasty is associated with a slightly greater risk of complication. Selected patients benefit from foramen magnum decompression alone, but further prospective randomized control studies are needed to learn more.
Keywords: Chiari malformation, Foramen magnum, Duraplasty