Clinical Outcome of Stealth Cranioplasty for Adult Chiari Malformation 1: An Encouraging Experience

Author(s): Asifur Rahman, Nazmin Ahmed, Abu Saleh Mohammad Abu Obaida, Abu Naim Wakil Uddin, Bipin Chaurasia, Md Atikur Rahman, Md Shamsul Alam, Md Moududul Haque, Marco Maria Fontanella, Edoardo Agosti.

Objectives: Regardless of the surgical techniques, outcomes of symptomatic adult Chiari malformation 1 (CM1) with or without syrinx (SX) are debatable. This study aimed to assess and compare the clinical outcomes of 2 surgical procedures: posterior fossa decompression with or without duraplasty (PFD±DP) and Stealth cranioplasty (SC).

Methodology: This comparative cross-sectional study was conducted on adult CM1 patients who underwent PFD±DP and SC, from June 2019 to May 2021. Clinical outcomes were evaluated and compared by changes in clinical symptoms and signs, the Chicago Chiari Outcome Scale (CCOS) scoring, and the rate of complications.

Results: This study was conducted on 53 symptomatic adult CM1 patients of an average age of 30.35 ± 7.49 years, with or without SX. 30 patients (56.6%) underwent PFD±DP and 23 (43.4%) underwent SC. No significant statistical difference in postoperative changes in symptoms or neurological findings was found between the 2 groups. The mean CCOS score of the SC group (13.00 ± 1.78) was significantly better (p 0.001) than the PFD±DP (11.46 ± 1.25) group. Categorizing outcomes into groups based on CCOS was also significantly better (p 0.001) in the SC group. 11 patients (36.7%) had complications in the PFD±DP group while none of the patients in the SC group had complications which was statistically significant (p 0.003).

Conclusion: The SC group fared better than the PFD±DP group concerning outcomes based on CCOS and rate of complications. Thus, SC can be a good option in managing symptomatic adult Chiari malformation 1 with or without syrinx.