Development , validation , and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients
OBJECT Chiari malformation Type I ( CM-I ) is a common and often debilitating neurological disease .
Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes .
Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome.
OBJECT The choice of surgical technique for decompressive surgery in patients with Chiari I malformation is controversial . Good preliminary postoperative outcomes have been achieved in patients with Chiari I malformation ( without syringomyelia ) after using a dura-splitting technique . The authors evaluated safety , re source use , and early outcome after this surgery in patients without syringomyelia and compared the findings associated with duraplasty in patients with syringomyelia . METHODS A prospect i ve series of 24 patients with Chiari I malformation ( 12 with a syrinx ) underwent decompression of the craniocervical junction ( CCJ ) .  An allograft-augmented duraplasty was performed in patients with syringomyelia . Intraoperative ultrasonography confirmed adequate tonsillar decompression after lysis of the periosteal b and s at the foramen magnum and C-1 arch as well as partial resection of the outer leaf of the dura in patients without syringomyelia . Patients in each group were of similar mean age ( syringomyelia 10.8 years and no syringomyelia 7.6 years old ; p = 0.07 ) and functional status . The mean follow-up period was 15.3 months ( range 3 - 30 months ) . Dura-splitting decompression required significantly less mean operative time ( 99 minutes compared with 169 minutes , respectively ; p < 0.001 ) , total operating room time ( 166 minutes compared with 249 minutes , respectively ; p < 0.001 ) , duration of hospitalization ( 3 days compared with 3.75 days , respectively ; p < 0.05 ) , perioperative charges ( $ 3615 compared with $ 5538 , respectively ; p < 0.001 ) , and overall hospital charges ( $ 7705 compared with $ 9759 , respectively ; p < 0.001 ) than the duraplasty . Mean clinical outcome scores were similar ( syringomyelia 1.53 of 2 ; no syringomyelia 1.67 of 2 ; not statistically significant ) . CONCLUSIONS Dura-splitting CCJ decompression in pediatric patients with Chiari I malformation and without syringomyelia is safe , provides good early clinical results , and significantly reduces re source use . A r and omized controlled trial of dura-splitting decompression in a uniform population of patients with Chiari I malformation is indicated
Development , validation , and incorporation of a small number of disease-specific patient-based instruments will improve the quality of research and care of CM-I patients
OBJECT Chiari malformation Type I ( CM-I ) is a common and often debilitating neurological disease .
Efforts to improve treatment of CM-I are impeded by inconsistent and limited methods of evaluating clinical outcomes .