Posterior Fossa Decompression Followed by Duraplasty with Arachnoid-Preserving Technique for Primary and Recurrent Adult Chiari Malformation Type-1.5: A Comparative Retrospective Study

Abstract

Objective Most studies on Chiari malformation (CM) are focused on CM Type-1. A new subtype, CM Type-1.5, lacks sufficient research. This study aims to evaluate the long-term surgical outcomes of posterior fossa decompression followed by duraplasty with arachnoid-preserving (PFDD-AP) technique for primary and recurrent CM Type-1.5. Methods The medical charts of patients treated surgically for CM at our institute between January 2011 and January 2022 were reviewed retrospectively. Adult patients consecutively treated for CM Type-1.5 were selected as the core sample for the current study. Group A included primary cases (i.e., patients who had not previously been surgically treated), and Group B included recurrent cases. The surgical outcomes were compared by evaluating clinical and radiological findings. Results Thirty-four CM Type-1.5 cases out of 202 CM cases met the study criteria. Twenty-three and 11 cases represented Group A and Group B, respectively. The female-to-male ratio was 2/1. In Group B, the preoperative herniated tonsil extension and the obex position were statistically significantly longer, and retroversion and retroflexion angles were statistically considerably smaller ([ p = 0.024; Z = - 2.26]; [ p = 0.023; Z = - 2.27]; [ p = 0.031; Z = - 2.29]; and [ p = 0.0002; Z = - 3.72], respectively). For the cases presented with syringomyelia (SM) in both groups ( n = 20), total and partial regression were recorded postoperatively in 65% and 15% of cases, respectively. The satisfactory recovery or improvement rate in neurological symptoms was 94.1%. Discussion Total or partial SM regression occurred following PFDD-AP in most adult patients with CM Type-1.5 who presented with SM. The PFDD-AP approach offers better results with fewer complications and recurrence rates.