Retrospective evaluation of patients who underwent duraplasty and vertical incision dural release for isolated Type 1 Chiari Malformation

Objective: The technical differences used in Chiari Malformation Type 1 surgery are a matter of debate today. Generally, duraplasty or dural release methods with vertical incisions are used after bone decompression. Both approaches have their own advantages and disadvantages. In this study, we aimed to contribute to the literature by comparing the results of both methods applied by us. Materials and Methods: The study consists of a total of 33 patients diagnosed with isolo Chiari Malformation Type 1, who underwent 23 duraplasty and 10 dural release techniques with vertical incisions. File data, surgery notes, radiological images and outpatient clinic follow-up notes of all operated patients were examined retrospectively, and the obtained data were analyzed with the help of SPSS program. Results: The average age of all operated patients was 32.51 ± 15.61, 13 (39.4%) were male and 20 (60.6%) were female. The most common complaints were headache and numbness in the extremities, with a rate of 42.4%. The most common physical examination finding was motor deficit with 33.3%, and the most common complications were meningitis and CSF fistula with 12.1%. The average preoperative Syrinogomyelia thickness was measured as 6.62±2.85 mm and the average length of herniated cerebellar tonsils was 8.54±3.78 mm. When patients who underwent duraplasty and those who underwent vertical incision dural release were evaluated separately, it was determined that the vertical incision dural release technique was advantageous in terms of complications, especially meningitis and CSF fistula, and the duration of the operation, and no statistical significance was observed between the results. It was determined that the short hospital stay was statistically significant in favor of the vertical incision dural release method. It was observed that the clinical recovery rates were close to each other. The regression in syringomyelia and the mean Chicago Final State Scale scores were determined in favor of duraplasty, and no statistical significance was observed. Conclusion: There is no absolute superiority among the preferred methods in the surgical treatment of Chiari Malformation Type 1. The results of our study are consistent with the general literature on this subject. Duraplasty is a very effective technique in Chiari Malformation Type 1 surgery. However, our study has shown that good results can be obtained with the dural release technique with vertical incision, which has much fewer complications and hospital stays and gives similar results to the duraplasty technique in clinical and radiological improvements. In this context, more research is needed and we think that all Neurosurgeons should have technical and theoretical knowledge of both methods. Keywords: Chiari Malformation Type 1, duraplasty, dural release with vertical incision