The Great Debate: Posterior Fossa Decompression With or Without Duraplasty for Chiari Malformation & Syringomyelia

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2018 unite@thehill - Conference of Advocacy & Action

The diagnosis of a symptomatic Chiari malformation with syringomyelia may require surgical treatment. When treatment is indicated, most neurosurgeons agree that posterior fossa decompression is the treatment of choice to create more space so that CSF flow is restored to the area blocked by cerebellar tissue.

Some neurosurgeons suggest an extradural posterior fossa decompression (PFD). This procedure involves removal of bone at the base of the skull and sometimes the upper cervical vertebrae as well as any constrictive ligaments or soft tissue. The dura, a protective layer enclosing the brain and spinal cord, is left intact. Other neurosurgeons suggest a posterior fossa decompression with duraplasty (PFDD). In addition to the steps of the PFD, this procedure involves opening the dura and sewing in a small patch graft to create more space for CSF flow. These operations are likely to have different risks and benefits. So… which is better? PFD or PFDD? The trouble is... we just don't know.

Thanda Meehan, research coordinator at the main site of an ongoing study, describes the study that seeks to answer this question, for good.

Revised: 9/2019