World Neurosurg. 2021 Jun 4:S1878-8750(21)00819-6. doi: 10.1016/j.wneu.2021.05.124. Online ahead of print.
ABSTRACT
BACKGROUND: This study aimed to compare the effectiveness of posterior fossa decompression (PFD), posterior fossa decompression with duraplasty (PFDD), and posterior fossa decompression with resection of tonsils (PFDRT) in Chiari malformation type I (CMI). Furthermore, we aimed to evaluate the evidence supporting the efficacy of filum terminale sectioning (FTS), syringo-subarachnoid shunting (SSS), and syringo-peritoneal shunting (SPS) in CMI.
METHODS: PubMed, Cochrane, and Embase databases were screened for English-language studies published from inception until 11 of August 2020. A total of 3593 studies were identified through the searching process. Finally, 15 cohort studies were included in the systematic review and network meta-analysis.
RESULTS: No studies concerning FTS, SSS, and SPS were found eligible. There fore only PFD, PFDD, and PFDRT were compared. PFDD showed significantly higher incidence of complications (RR, 3.79; 95% CI, 2.54-5.64) cerebrospinal fluid (CSF) leak (RR, 9.74; 95% CI, 2.33-40.78) and neurologic deficit (RR, 8.76; 95% CI, 2.08-36.90) than PFD. Both PFDD and PFDRT achieved higher syringomyelia improvement (RR, 1.23; 95% CI, 1.09-1.39), (RR, 1.32; 95% CI, 1.15-1.51) and greater clinical improvement (RR, 1.24; 95% CI, 1.10-1.39), (RR, 1.24; 95% CI, 1.08-1.44) than PFD. We have not found any differences between PFDD and PFDRT.
CONCLUSIONS: PFDD and PFDRT are superior to PFD, especially in patients with syringomyelia-Chiari complex, due to greater syringomyelia reduction and better clinical improvement. However, PFDD and PFDRT can be considered equally efficient. There is no evidence pleading in favor of the SFT, SSS, and SPS over any posterior fossa decompression technique.
PMID:34098134 | DOI:10.1016/j.wneu.2021.05.124
