Decompression with Intradural Dissection for the Chiari Malformation Type I: Toward Eliminating Wound Complications

There is continuing conversation about surgical technique in the management of the Chiari malformation. Popular options include osseous decompression alone, decompression with dural splitting, and decompression with intradural dissection (DID) and duraplasty. Wound complications after intradural dissection are a persistent problem. The current study of an institutional series examines wound complication rates after intradural dissection without dural closure.

A retrospective single-institution chart review was performed for patients <21 years with Chari malformation type I who underwent DID without dural closure and had at least 6 months of follow-up. Bone removal corresponded to the area of attachment of the rectus capitis posterior minor muscles together with laminectomy of the atlas. The trapezius and semispinalis capitis muscles were retracted but were not separated from the occiput.

A total of 76 patients were treated from May 2010 through May 2024. Thirty-eight (50.0%) patients had syringomyelia. The median age at surgery was 9 years (interquartile range [IQR] 4-13), and the median follow-up was 3.68 years (IQR 1.42-5.39). The median length of surgery was 91 minutes (IQR 73-102), and the median total length of hospital stay was 3 days (IQR 2-4). There were no instances of cerebrospinal fluid wound fistula or symptomatic pseudomeningocele (95% confidence interval 0-3.9%).

DID without dural closure appears to eliminate wound complications in the management of the Chiari malformation type I.