A new concept and surgical approach for Chiari malformation type I based on the protection and strengthening of the myodural Bridge.

Abstract

Chiari malformation type I (CM-I) is the most common subtype of Chiari malformation which can lead to brainstem compression and alterations in cerebrospinal fluid (CSF) flow. Common complications in patients undergoing traditional surgical approach include pseudomeningocele, CSF leak, and exacerbation of symptoms. The authors present a new minimally invasive surgery technique for protection and strengthening of the myodural bridge (MDB) in order to prevent the postoperative complications. A retrospective study was performed on 55 CM-I patients undergoing surgical treatment from January 2019 to April 2024 in a center. These patients underwent the surgical procedure of either posterior fossa decompression with duraplasty and tonsillar coagulation (PFDDC) or PFDDC with protection and strengthening of the MDB (PFDDC + MDB). The clinical outcomes and complications of the two procedures. 29 patients underwent PFDDC, and 26 patients underwent PFDDC + MDB. Overall complications rates were significantly reduced in the PFDDC + MDB group (3.8% vs. 34.5%, P = 0.012). Meningitis was observed in 3 (10.3%) in the PFDDC group and 1 (3.8%) in the PFDDC + MDB group (P = 0.613). Pseudomeningocele was more frequent in the PFDDC group than in the PFDDC + MDB group (24.1% vs. 0%, P = 0.011). No patient required a revision operation. There were no statistical differences in symptom improvement between the two groups. PFDDC + MDB seems to be a safe and effective treatment for CM-I patients with or without syringomyelia. This new procedure can bring clinical improvement and lower complication rates.