Clinical outcome of different surgical approaches for symptomatic Chiari malformation without syringomyelia: a 13-year retrospective study.

Abstract

Chiari malformation, a condition that disrupts cerebrospinal fluid circulation. While previous studies have extensively explored the symptoms, treatment approaches, and clinical outcomes for patients with Chiari malformation accompanied by syringomyelia, there is limited research focused on those without syringomyelia. This study aims to evaluate the symptoms, treatments, intradural findings, and clinical outcomes in patients with Chiari malformation without syringomyelia. This single-center, retrospective study analyzed 148 patients diagnosed with Chiari malformation without syringomyelia between January 2010 and September 2022. Patients underwent one of two surgical approaches: posterior fossa decompression (PFD) or posterior fossa decompression with duraplasty (PFDD). Data on clinical symptoms, intradural findings, surgical outcomes, and postoperative complications were collected and analyzed. A total of 148 patients were included in the study, with 30 undergoing PFD and 118 receiving PFDD. Patients treated with PFDD showed significantly improved CCOS scores compared to those treated with PFD (12.8 ± 1.9 vs. 11.8 ± 2.5, P = 0.018). Symptom improvement rates were comparable between the two groups. Among PFDD patients, over 80% exhibited intradural abnormalities, with 28.4% classified as severe. Severe intradural abnormalities were strongly associated with higher rates of Valsalva-provoked pain (59.5% vs. 26.3%, P < 0.001). PFDD significantly improves CCOS scores compared to PFD, highlighting its potential as a more effective surgical approach for Chiari malformation without syringomyelia. Clinical trial number Not applicable.