Surgical Management of Chiari 1 Malformation in the Paediatric Population: A Systematic Review and Meta-analyses of Observational Studies

Abstract

Background: Chiari 1 malformation (C1M) is a congenital malformation in the paediatric population is commonly encountered and often requires surgical management. Currently there is no agreed consensus on the appropriate and specific surgical technique for management of paediatric cases of C1M. The purpose of this systematic review and meta-analysis is to compare the clinical outcomes of posterior fossa decompression with duraplasty (PFDD) to posterior fossa decompression alone (PFD) in paediatric patients. Methodology: Systematic review of electronic literature databases searched from January 1997 to March 2017 of paediatric patients that had posterior fossa decompression with comparative analysis of PFD and PFDD were considered for inclusion. A Meta-analyses on the retrieved data was performed. Results: Nine reports of eligible studies involving 3404 patients met the inclusion criteria. Of the 3404 patients, 1965 were treated with PFD alone while 1439 were treated with PFDD. Mean age range of 9.6 year to 11.1 years. Patients undergoing PFDD has significantly higher rates of pseudomeningocele formation OR 1.91, 95% C1 (1.30, 2.82) and lower complication rates OR 1.30, 95% CI (1.06, 1.61) than PFD. No significant difference in clinical improvement, reoperation rates, CSF leaks, wound infection and incidence of aseptic meningitis were observed. Conclusion: PFDD is associated with fewer complications when compared to PFD alone. However the incidence of pseudomeningocoele formation is more commonly encountered following PFDD compared to PFD. PFDD is also more commonly performed following a failed improvement in symptomatology following PFD. Multicentre randomised controlled studies are needed to definitively identify the gold-standard technique for the management of  answer to best surgical technique.