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More Evidence that Riskiest Part of Chiari Surgery May Not be Necessary

Dr. Neil Feldstein and Dr. Richard Anderson at the Pediatric Neurosurgery Center have treated a lot of children with a neurological birth defect called a Chiari malformation (CM). Treatment often involves a surgery at the top of the spine.

Increasingly, they are finding that the riskiest part of their surgical treatment, that is, opening the protective tissue, called the dura mater (image left), that surrounds the spinal cord, may not always be necessary.

They completed a research project that looked at children with Chiari malformation that had caused their spines to also develop a scoliosis (image below right). Drs. Feldstein and Anderson with fellow researchers* wanted to see if opening the dura made a difference on how the scoliosis responded to the Chiari treatment. They presented their research at a meeting of the Pediatric Neurosurgery Section**.

A Chiari malformation is a boney irregularity near the opening of skull that can cause increased pressure on the lower part of the brain and the spine. In some cases, this causes the spinal column to curve and create a scoliosis.

The surgical treatment for this problem aims to remove this pressure. A small amount of bone is removed from the back of the skull and neck. It is also standard for surgeons to open up the dura mater to relieve pressure. The dura, short for dura mater, is a thick lining that surrounds the brain and spinal cord creating a closed system. Coursing through this system is spinal fluid that regulates pressure and cushions these vital structures.

Though it is patched afterward, opening the dura is risky because it makes this protected system vulnerable to contamination such as meningitis or leaks that can create a dangerous disruption of the pressure system. Their research indicates that this part of the procedure may not always be worth the risk.scoliosis

They looked at patients with scoliosis and Chiari malformation who had had surgery at this institution since 1995. The patients treated until 2003 had their dura opened and after that year the dura was not opened unless the scoliosis progression was unusually rapid.

The degree of scoliosis and neurological symptoms like limb weakness, hyperactive reflexes, and difficulty swallowing were assessed before and after surgery and compared between these two groups. Their results showed that improvements following surgery were more or less the same with or without dural opening.

There was a slightly higher chance that a second surgery would be needed in the non-dural-opening group, but this group also had significantly fewer complications.

This was the first study of it’s kind and the authors encourage other neurosurgeons to compare their results with and without dural opening.  It may be that this part of the surgery isn’t always necessary and they can expose fewer children to these risks.

Learn more about Dr. Neil Feldstein on his bio page here.
Learn more about Dr. Richard Anderson on his bio page here.

*Researchers involved in this study were: TC Hankinson, J Wade, C Shannon, S Ghatan, RCE Anderson, and NA Feldstein

**The Pediatric Neurosurgery Section is a joint venture of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

Originally published Feb 19, 2010
Updated April 19, 2017

patient journey

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