• Eveline Teresa Hidalgo, Yosef Dastagirzada, Cordelia Orillac, Svetlana Kvint, Emily North, Ramona Bledea, Michelle W McQuinn, Gabriel Redel-Traub, Crystalann Rodriguez, and Jeffrey H Wisoff.
• Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Health, New York, New York, USA. Electronic address: Teresa.Hidalgo@nyumc.org.
• World Neurosurg. 2018 Sep 1; 117: e544-e551.

BackgroundDuraplasty is a technique successfully used to treat Chiari malformation type I (CM-I). This study describes the timely manner of clinical outcomes and the postoperative course after craniectomy and duraplasty for the treatment of symptomatic CM-I in children.MethodsA retrospective chart review was performed in 105 consecutive children who underwent surgical decompression of symptomatic CM-I with dural opening by a single surgeon between 1999 and 2015.ResultsIn 16 of 28 children (57%) with typical Valsalva-related/tussive and mixed headaches, the symptoms resolved before discharge; by 6 months, all children were headache-free. Two of 28 children (7%) had recurrent headaches 9 months after surgery. Among the 78 children with syrinx, syrinx resolved or decreased in 68 (87%), recurred in 8 (10%), and was stable in 2 children (3%). Syrinx was resolved or decreased by 3 months in 51 children (65%) and by 6 months in 62 children (79%). Complications included aseptic meningitis requiring reoperation in 3 children (3%) and infection in one child (1%). Twelve children underwent reoperation, none within the first 30 days. No child had a major morbidity or mortality.ConclusionsIn carefully selected children with CM-I, a high success rate can be achieved with suboccipital decompression and duraplasty. Valsalva-related/tussive headaches resolved by the time of discharge from the hospital in the majority of children, and syrinx resolved or decreased in two-thirds of the children by 3 months. By 6 months, headaches were resolved in all cases, and syrinx was resolved or decreased in 79% of cases.Copyright © 2018 Elsevier Inc. All rights reserved.

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