{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:57:29Z","timestamp":1792515449558,"version":"4.5.0"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The optimal surgical management of Chiari malformation type I (CM-I) remains controversial and heterogeneous. The authors sought to investigate patient-specific, technical, and perioperative features that may affect the incidence of CSF-related complications including pseudomeningocele and CSF leak at their institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a single-center, retrospective review of all adult patients with CM-I who underwent posterior fossa decompression. Patient demographics, operative details, and perioperative factors were collected via electronic medical record review. The authors performed Fisher\u2019s exact test and independent Student t-tests for categorical and continuous variables, respectively. Univariate regression analysis was performed to determine odds ratios. A multivariable regression analysis was performed for those factors with p &lt; 0.10 or large effect sizes (OR \u2265 2.0 or \u2264 0.50) by univariate analysis. The STROBE guidelines for observational studies were followed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 59 adult patients were included. Most patients were female (78.0%), and the mean body mass index was 32.2 (\u00b1 9.0). Almost one-third (30.5%) of patients had a syrinx on preoperative imaging. All patients underwent expansile duraplasty, of which 47 (79.7%) were from autologous pericranium. Arachnoid opening for fourth ventricular inspection was performed in 26 (44.1%) cases. CSF-related complications were identified in 18 (30.5%) of cases. Thirteen (22.0%) patients required readmission and 11 (18.6%) required intervention such as wound revision (n = 5), wound revision with CSF diversion (n = 4), CSF diversion alone (n = 1), or blood patch (n = 1). Three (5.1%) patients required permanent CSF diversion. Male sex (OR 3.495), diabetes mellitus (OR 0.249), tobacco use (OR 2.53), body mass index more than 30 (OR 2.45), preoperative syrinx (OR 1.733), autologous duraplasty (OR 0.331), and postoperative steroids (OR 2.825) were included in the multivariable analysis. No factors achieved significance by univariate or multivariable analysis (all p &gt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The authors report a single-center, retrospective experience of posterior fossa decompression for 59 adults with CM-I. No perioperative or technical features were found to affect the CSF-related complication rate. More standardized practices within centers are necessary to better delineate the true risk factors and potential protective factors against CSF-related complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2022.12.focus22631","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T10:07:02Z","timestamp":1677665222000},"page":"E8","source":"Crossref","is-referenced-by-count":6,"title":["Incidence and management of postoperative pseudomeningocele and cerebrospinal fluid leak after Chiari malformation type I decompression"],"prefix":"10.3171","volume":"54","author":[{"given":"Travis J.","family":"Atchley","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasaman","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Gross","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas M. B.","family":"Laskay","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dagoberto","family":"Estevez-Ordonez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip G. R.","family":"Schmalz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfield S.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Acta Neurochir (Wien)","first-page":"589","article-title":"Cerebrospinal fluid disturbance in overweight women after occipitocervical decompression in Chiari malformation type I","volume":"158","author":"Almotairi FS","year":"2016","unstructured":"Almotairi FS, Tisell M. Cerebrospinal fluid disturbance in overweight women after occipitocervical decompression in Chiari malformation type I. Acta Neurochir (Wien). 2016;158(3):589\u2013594. 26743916"},{"issue":"10","key":"b2","series-title":"Childs Nerv Syst","first-page":"1711","article-title":"Chiari I malformation and altered cerebrospinal fluid dynamics\u2014the highs and the lows","volume":"35","author":"Mukherjee S","year":"2019","unstructured":"Mukherjee S, Kalra N, Warren D,  Chiari I malformation and altered cerebrospinal fluid dynamics\u2014the highs and the lows. Childs Nerv Syst. 2019;35(10):1711\u20131717. 31203396"},{"key":"b3","series-title":"Clin Neurol Neurosurg","first-page":"182","article-title":"Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I","volume":"125","author":"Chotai S","year":"2014","unstructured":"Chotai S, Medhkour A. Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I. Clin Neurol Neurosurg. 2014;125:182\u2013188. 25171392"},{"key":"b4","series-title":"World Neurosurg","first-page":"e579","article-title":"Posterior fossa decompression and duraplasty with and without arachnoid preservation for the treatment of adult Chiari malformation type 1: a systematic review and meta-analysis","volume":"151","author":"Osborne-Grinter M","year":"2021","unstructured":"Osborne-Grinter M, Arora M, Kaliaperumal C, Gallo P. Posterior fossa decompression and duraplasty with and without arachnoid preservation for the treatment of adult Chiari malformation type 1: a systematic review and meta-analysis. 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An evidence-based review of the pediatric Chiari I malformation. Childs Nerv Syst. 2011;27(1):35\u201340."},{"issue":"2","key":"b7","series-title":"World Neurosurg","first-page":"307","article-title":"When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale?","volume":"75","author":"Yilmaz A","year":"2011","unstructured":"Yilmaz A, Kanat A, Musluman AM,  When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale?. 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