Comparison Of Posterior Fossa Decompression With And Without Duraplasty For Surgical Treatment Of Chiari Malformation Type ?

Objective At present,there are still many controversies about the clinical surgical techniques used to treat Chiari malformation.Whether or not dural decompression was performed after skeletal decompression did not reach consensus.There are currently many comparisons between PFD and PFDD procedures,and there are few comparisons between simple epidural lysis and dural surgery.The main purpose of this study was to review the efficacy of PFD treatment in patients without dural incision,and to compare the efficacy of treatment with duraplasty.Explore the appropriate surgery for treating Arnold-Chiari I malformation.Methods A retrospective analysis of patients who underwent surgery in our hospital from January 2008 to December 2016 was performed.They were divided into two groups of AB.A total of 23 patients(A group)who underwent posterior cervical sacral posterior arch and posterior cranial lobectomy decompression combined with epidural lysis were recorded.The posterior arch of the posterior cervical spine and posterior cranial stalk decompression were performed.There were a total of 32 patients who underwent surgery and duralotomy,group B.By comparing the operation time,incision size,intraoperative bleeding,postoperative complications and surgical outcomes,it was divided into three phases(3 months,6 months,1-2 years)for follow-up statistical analysis.Results The improvement rate in group A was 87.0%;the improvement rate in group B was 81.3%.P=0.753>0.05.There was no statistical difference between the two groups.The operation time was(81.91 ± 7.01 min in group A,117.34 ± 7.64min P<0.05 in group B),incision size(7.44 ±0.64cm in group A,10.97 ±0.65cm in group B P<0.05),intraoperative bleeding(group A 94.74 ±)12.89ml,B group 134.03 ±25.56ml P<0.05)and hospital stay(A group 5.09 ± 1.41d,B group 7.06 ± 1.46d P<0.05)There was a statistically significant difference.And it has statistical significance.The size of the bone window(group A 10.70± 1.77cm2,group B 10.38± 2.30cm2 P>0.05)was not statistically different.Conclusion Once diagnosed as Arnold-Chiari type I patients,if associated with clinical symptoms,the condition is progressive,and surgery should be used as the main treatment.We believe that no matter what kind of surgery is used,it is a prerequisite for patients to obtain a better quality of life.We recommend that the dura mater is an open epidural lysis procedure.This type of surgery results in a similar curative effect to that of duraplasty with shorter operative time and hospital stay,more minimally invasive surgical incision,and less surgical bleeding.