Comparison of Dural Graft Types and Graft Fixation Methods in Chiari Malformation Type I Decompression Surgery.

Abstract

Suboccipital decompression with duraplasty is being increasingly accepted for treating patients with Chiari malformation type I (CM-1). To date, the optimal duraplasty for CM-I has not been delineated. This study aims to compare the clinical and radiologic effects of duraplasty performed using 2 types of grafts and 2 graft fixation methods in 3 combinations. In this retrospective study, 84 consecutive decompressions with duraplasty were analyzed. Two types of grafts (nonautologous [Non-Auto G], 90.5% and autologous [Auto G], 9.5%) and 2 graft fixations (suturing [S], 31.0%; and suturing plus gluing [S + G], 69.0%) were used in 3 different combinations: Non-Auto G S: 31.0%; Non-Auto G S + G: 59.5%, and Auto G S + G: 9.5%. All patients were followed up for 3 months. Clinical results were evaluated using the Gestalt scale, and syringomyelia results were evaluated using magnetic resonance imaging. According to the Gestalt scale, 82.1% of the patients showed improvement 3 months post operation, and the improvement was not related to the type of graft (P = 0.90), fixation (P = 0.90), or duraplasty (P = 0.81). Decreased syringomyelia was observed in 76.4% of the patients. It was not associated with the graft (P = 0.53), fixation (P = 0.72), or duraplasty (P = 0.80). Meningitis occurred in the Auto G S + G, Non-Auto G S + G and Non-Auto G S groups (25%, 48%, and 23.1%, respectively; P = 0.30), and their formations were not related to the k graft type (P = 0.57) or fixation (P = 0.19). Autologous and nonautologous dural grafts can be performed using either sutures or sutures plus glue, as both result in similar outcomes.