Outcome of Posterior Fossa Decompression with Duraplasty by Different Types of Graft in Patients with Chiari Malformation Type I

Abstract

Background: Chiari malformation type I (CM-I) is treated surgically by suboccipital craniectomy with or without duraplasty. Duraplasty may be performed using a variety of dural grafts, including autologous pericranium, allografts, xenografts, and synthetic substitutes. Aim of the work:To assess outcome and CSF leakage incidence according to type of dural graft in CM-I patients. Patients and methods: This study included twenty-eight patients with Chiari malformation type I who underwent posterior fossa decompression with duroplasty were randomly assigned into two equal groups: Group A (N=14): patients were treated with a dural substitute Engineered collagen matrix grafts (DuraGen). Group-B (N=14): patients were treated with free tissue fascia lata graft. All patients had neurological assessment and basal laboratory investigations. Magnetic resonance imaging (MRI) of the brain and craniocervical junction as well as computed tomography (CT) of the brain were done preoperatively.. Results: Regarding clinical outcome, fascia lata group showed higher significant excellent rate (92.9%) than DuraGen group (57.1%) (p=0.032). Also, one patient showed good outcome and none showed poor outcome in patients with fascia lata graft while there were four patients with good outcome, two with poor outcome in DuraGen graft patients without significance. Considering postoperative complications, only one patient (7.1%) in fascia lata group showed tight bandage while DuraGen group showed eight patients (57.1%) with CSF leakage (p=0.001), four patients (28.6%) needed reoperations (p=0.033), two cases (14.3%) with Aseptic meningitis and ten cases (71.4%) with tight bandage (p < 0.001). Conclusion: CM-I decompression surgery with duraplasty by fascia lata graft has a better outcome and lower significant rate of CSF leakage and other postoperative complications than engineered collagen graft (DuraGen).