Transcript Dural splitting

Surgical Results from Chiari
Decompression: Comparing
Duroplasty versus Dural Splitting
Techinques
John A. Jane, Jr., M.D.
Associate Professor of Neurosurgery and
Pediatrics
Director of Pediatric Neurosurgery
University of Virginia Health System
Disclosures
• None
Surgical Technique
• Bone removal:
– Posterior fossa decompression aka
suboccipital craniectomy aka
foramen magnum decompression
– C1 laminectomy, sometimes C2
and/or C3
Dural splitting
• The spinal dura only
has one layer
• “Dural splitting” over
the spine is not really
splitting two layers
Surgical Technique
• Decompression
(bone removal)
alone
• Dural splitting
– Use of intraoperative
ultrasound
– Type of splitting
• Creation and removal
of an outer layer
Surgical Series
• 2006-2009, Age<18
• N=16
– Posterior fossa decompression and duraplasty=8
• 6 syringomyelia
– Posterior fossa decompression alone=8
• 6 syringomyelia
– Both groups similar in terms of age, symptoms, degree
of tonsillar herniation, and syringomyelia
Outcomes
• Syringes
– Significantly decreased or resolved in 5 of 6 patients in
each group
• Tonsillar regression
– PFD alone: 6 of 7
– PFD plus duraplasty: 5 of 7
PFD with dural splitting
PFD with dural splitting
Complications
• Postoperative nausea
– PFD alone: 0/8
– PFD with duraplasty: 5/8
• Higher rate of complications associated
with PFD with duraplasty
– Meningitis, Reoperation for CSF leak, Symptomatic
pseudomeningocele
Complications
• Original surgery:
PFD with division
of adhesions and
continuous
sutured duraplasty
Complications
• Chemical meningitis: repeat PFD with
removal of dural graft and placement
of pericranial graft
• Pseudomeningocele with CSF leak
requiring repeat closure of incision
• Continued pseudomeningocele treated
with a ventriculoperitoneal shunt
Recent reports
• Decompression alone procedures were
shorter, had shorter hospital stays, and
less pain and nausea
• However, PFD alone was associated
with a higher incidence of symptomatic
recurrence and need for dural opening
(12.5% versus 3.1%)
Conclusions
• Posterior fossa decompression with
dural splitting is better tolerated and
associated with fewer complications
than PFD with duraplasty
• Posterior fossa decompression with
dural splitting can provide effective
treatment of syringomyelia in most
patients
Thank you!
Questions?