Posterior fossa decompression with or without duraplasty for patients with chiari type I malformation and basilar impression: a meta-analysis

Background To compare clinical effect and safety between posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) in treatment of Chiari type I malformation and basilar impression. Methods A comprehensive computer search was conducted from 2000 to 2019. The quality assessment was performed by the QUADAS-2 tool. The clinical value of comparison between PFDD and PFD was evaluated by using the pooled estimate of sensitivity and specificity. In addition, sensitivity analysis and bias analysis were applied to ensure the accuracy of the results. Results Finally, 468 patients were enrolled in 6 studies and ultimately met the eligibility criteria. The PFDD and PFD groups were 282 and 186, respectively. The meta-analysis showed no significant difference in the Chicago Chiari Outcome Scale (COSS score) (MD = 0.14, 95% CI [−0.23, 0.50], P = 0.47; P = heterogeneity = 0.86, I 2 = 0%). Meanwhile, Significant difference existed in length of stay (MD = −1.08, 95% CI [−1.32, −0.84], P = 0.001; heterogeneity P < 0.000001, I 2 = 85%) and complications (OR = 0.35, 95%CI [0.20, 0.62], P = 0.0003; P for Heterogeneity = 0.04, I 2 = 56%). Conclusion PFD is a more efficient and safer therapy than PFDD in the treatment of Chiari type I malformation with basilar impression.