Retrospective comparison of the effects of duraplasty and dural splitting on patients with chiari type 1 malformation and their effects on treatment results

Introduction: Although a standard surgical technique has not been established in the surgical treatment of Chiari type 1 malformation, duraplasty following suboccipital craniectomy remains the most preferred surgical technique. In recent years, the dural splitting technique, which was made by peeling the outer layer of dura, is also used. In this study, we aimed to demonstrate clinically and radiologically the superiority of two surgical treatment techniques, which one of them is less invasive. Methods: The data of 28 patients who were diagnosed as Chiari type 1 malformation and operated at the Department of Neurosurgery of Bülent Ecevit University between January 2014 and April 2018 were retrospectively evaluated. Demographic characteristics, symptoms, physical and neurological examination findings, preoperative and postoperative radiological imaging data were obtained from the automation system. Preoperative and postoperative evaluation results of the patients were also obtained through the automation system. Preoperative and postoperative radiological images of the patients were examined by means of the automation system and necessary measurements and data were obtained. In 17 patients, duraplasty was performed following suboccipital craniectomy, and in 11 patients, the dura splitting technique followed the suboccipital craniectomy, and the outer layer of dura was peeled off and microincisions were made on the inner layer. Results: The mean age of the patients included in the study was 38.5 ± 13, and the ratio of female to male was 2.1/1. Syringomyelia had been seen %50 of all cases. The mean tonsil herniation length was 11.64 ± 4 mm and the mean tonsillo-dural distance was 4.18 ± 1.7 mm. There was no significant relationship between tonsil herniation length and the presence of syringomyelia. No statistically significant difference was observed between tonsillo-dural distance and clinical improvement. There were no significant differences evaluations on the treatment of Chiari type 1, between duraplasty and dural splitting techniques in VAS, Chicago Chiari Outcome Scale, Neck Disability Index, Neurological Scoring System and modified JOA score. In terms of hospital stay, operation time and complication rates, significant results was observed in favor of dural splitting technique. Conclusion: Duraplasty performed following suboccipital craniectomy is an effective surgical method for the treatment of Chiari type 1 malformation. Dural splitting performed following suboccipital craniectomy then peeling outer layer of dura and then microincisions to the inner layer is an effective surgical method for the treatment of Chiari type 1 malformation. Dural splitting technique is seen as a good alternative with lower complication, rate, especially in CSF fistula, shorter operation time and shorter hospital stay.