{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:26Z","timestamp":1780736486176,"version":"3.54.1"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This study investigated whether the selection of different dural substitutes and distinct dural repair techniques correlates with the incidence rate of postoperative CSF leak in a mixed population of adults and children with Chiari type I malformation (CM-I) who underwent posterior fossa decompression with enlargement duraplasty (PFDD) as the first surgical approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on all patients admitted to the authors\u2019 institution between 2006 and 2023 for PFDD to treat syringomyelia and\/or symptoms due to CM-I. Clinical, radiological, and surgical data were extracted from a prospectively maintained database. Demographic information was collected from medical records. Surgical procedures were also scrutinized, specifically focusing on the type of dural graft used for duraplasty, alongside perioperative complications and the necessity for subsequent surgeries. Lastly, during follow-up, the occurrence of a CSF leak was assessed and analyzed in relation to the type of dural graft used during surgery. The type of dural substitute chosen changed over the years to reduce CSF fistulas, while the technique of PFDD remained the same. Consequently, large sequential homogeneous groups differing only by dural substitutes were available for comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The data from 409 patients with CM-I undergoing PFDD were analyzed. A total of 368 cases had complete surgical data and were included. Thirty patients received autologous duraplasty. The remaining 338 cases with heterologous duraplasty from equine and bovine pericardium were considered for the comparative statistical analysis. The mean follow-up duration ranged from 39 months in adults to 45 months in children. The CSF complication rate requiring revision was 6.5% in the total cohort, with a higher incidence in children (10.5%) compared with adults (3.9%). There was no significant difference in adverse events (CSF leak, revision surgery, or ventriculoperitoneal shunt placement) between the different dural patches by univariate analysis if applied to the total cohort, although the trend neared significance (p = 0.06). In pediatric cases, this value was significant (p = 0.01) in favor of equine pericardium, particularly when combined with a collagen matrix inlay graft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study on a large and homogeneous series of patients with CM-I undergoing PFDD with heterologous duraplasty demonstrated that CSF complications may be kept low. The dural substitutes derived from equine pericardium, particularly when combined with a collagen matrix inlay graft, exhibited a reduced rate of CSF leaks compared with substitutes derived from bovine pericardium.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.focus24710","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T06:53:18Z","timestamp":1738392798000},"page":"E13","source":"Crossref","is-referenced-by-count":2,"title":["Which type of duraplasty is best for Chiari type I malformation surgery?"],"prefix":"10.3171","volume":"58","author":[{"given":"Laura Grazia","family":"Valentini","sequence":"first","affiliation":[{"name":"Department of Neurosurgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Saletti","sequence":"additional","affiliation":[{"name":"Developmental Neurology Unit, Mariani Foundation Center for Complex Disabilities;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Moscatelli","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Farinotti","sequence":"additional","affiliation":[{"name":"Neuroepidemiology Unit\u2013Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Barbotti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignazio Gaspare","family":"Vetrano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso Francesco","family":"Galbiati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Ann Ist Super Sanita","first-page":"48","article-title":"Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort","volume":"56","author":"Ciaramitaro P","year":"2020","unstructured":"Ciaramitaro P, Garbossa D, Peretta P,  Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort. Ann Ist Super Sanita. 2020;56(1):48\u201358."},{"issue":"2","key":"b2","series-title":"Neurol Sci","first-page":"1311","article-title":"Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document","volume":"43","author":"Massimi L","year":"2022","unstructured":"Massimi L, Peretta P, Erbetta A,  Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document. Neurol Sci. 2022;43(2):1311\u20131326."},{"issue":"2","key":"b3","series-title":"Neurol Sci","first-page":"1327","article-title":"Diagnosis and treatment of Chiari malformation and syringomyelia in adults: international consensus document","volume":"43","author":"Ciaramitaro P","year":"2022","unstructured":"Ciaramitaro P, Massimi L, Bertuccio A,  Diagnosis and treatment of Chiari malformation and syringomyelia in adults: international consensus document. Neurol Sci. 2022;43(2):1327\u20131342."},{"issue":"6","key":"b4","series-title":"Childs Nerv Syst","first-page":"691","article-title":"Relevance of surgical strategies for the management of pediatric Chiari type I malformation","volume":"23","author":"Galarza M","year":"2007","unstructured":"Galarza M, Sood S, Ham S. Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Childs Nerv Syst. 2007;23(6):691\u2013696."},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"922","article-title":"Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization","volume":"72","author":"Litvack ZN","year":"2013","unstructured":"Litvack ZN, Lindsay RA, Selden NR. Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization. Neurosurgery. 2013;72(6):922\u2013929."},{"issue":"8","key":"b6","series-title":"Childs Nerv Syst","first-page":"1419","article-title":"Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation","volume":"30","author":"Lee A","year":"2014","unstructured":"Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD. Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation. Childs Nerv Syst. 2014;30(8):1419\u20131424."},{"issue":"2)(suppl","key":"b7","series-title":"J Neurosurg","first-page":"184","article-title":"Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome","volume":"101","author":"Limonadi FM","year":"2004","unstructured":"Limonadi FM, Selden NR. Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome. J Neurosurg. 2004;101(2)(suppl):184\u2013188."},{"key":"b8","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."},{"key":"b9","series-title":"Clin Neurol Neurosurg","first-page":"1","article-title":"Comparison decompression by duraplasty or cerebellar tonsillectomy for Chiari malformation-I complicated with syringomyelia","volume":"176","author":"Jia C","year":"2019","unstructured":"Jia C, Li H, Wu J,  Comparison decompression by duraplasty or cerebellar tonsillectomy for Chiari malformation-I complicated with syringomyelia. Clin Neurol Neurosurg. 2019;176:1\u20137."},{"key":"b10","first-page":"147","article-title":"Evaluation of adult and pediatric Chiari type 1 malformation patients: do consensus documents fit everyday practice? Acta Neurochir Suppl","volume":"135","author":"Valentini LG","year":"2023","unstructured":"Valentini LG, Galbiati TF, Saletti V,  Evaluation of adult and pediatric Chiari type 1 malformation patients: do consensus documents fit everyday practice? Acta Neurochir Suppl. 2023;135:147\u2013155."},{"issue":"1","key":"b11","series-title":"Surg Neurol Int","first-page":"26","article-title":"The need in dural graft suturing in Chiari I malformation decompression: a prospective, single-blind, randomized trial comparing sutured and sutureless duraplasty materials","volume":"4","author":"Williams LE","year":"2013","unstructured":"Williams LE, Vannemreddy PS, Watson KS, Slavin KV. The need in dural graft suturing in Chiari I malformation decompression: a prospective, single-blind, randomized trial comparing sutured and sutureless duraplasty materials. Surg Neurol Int. 2013;4(1):26."},{"key":"b12","series-title":"World Neurosurg","first-page":"460","article-title":"Comparison of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I: a systematic review and meta-analysis","volume":"110","author":"Lin W","year":"2018","unstructured":"Lin W, Duan G, Xie J, Shao J, Wang Z, Jiao B. Comparison of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I: a systematic review and meta-analysis. 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Commentary on the 2021 Chiari and Syringomyelia Consensus Document","volume":"135","author":"Massimi L","year":"2023","unstructured":"Massimi L, Vetrano IG, Peretta P,  Chiari malformation type 1 and syringomyelia: why do patients claim for international guidelines? Commentary on the 2021 Chiari and Syringomyelia Consensus Document. Acta Neurochir Suppl. 2023;135:139-145."},{"issue":"1","key":"b1","series-title":"Ann Ist Super Sanita","first-page":"48","article-title":"Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort","volume":"56","author":"Ciaramitaro P","year":"2020","unstructured":"Ciaramitaro P, Garbossa D, Peretta P,  Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort. Ann Ist Super Sanita. 2020;56(1):48\u201358."},{"issue":"2","key":"b2","series-title":"Neurol Sci","first-page":"1311","article-title":"Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document","volume":"43","author":"Massimi L","year":"2022","unstructured":"Massimi L, Peretta P, Erbetta A,  Diagnosis and treatment of Chiari malformation type 1 in children: the International Consensus Document. Neurol Sci. 2022;43(2):1311\u20131326."},{"issue":"2","key":"b3","series-title":"Neurol Sci","first-page":"1327","article-title":"Diagnosis and treatment of Chiari malformation and syringomyelia in adults: international consensus document","volume":"43","author":"Ciaramitaro P","year":"2022","unstructured":"Ciaramitaro P, Massimi L, Bertuccio A,  Diagnosis and treatment of Chiari malformation and syringomyelia in adults: international consensus document. 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Neurosurgery. 2013;72(6):922\u2013929."},{"issue":"8","key":"b6","series-title":"Childs Nerv Syst","first-page":"1419","article-title":"Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation","volume":"30","author":"Lee A","year":"2014","unstructured":"Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD. Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation. Childs Nerv Syst. 2014;30(8):1419\u20131424."},{"issue":"2)(suppl","key":"b7","series-title":"J Neurosurg","first-page":"184","article-title":"Dura-splitting decompression of the craniocervical junction: reduced operative time, hospital stay, and cost with equivalent early outcome","volume":"101","author":"Limonadi FM","year":"2004","unstructured":"Limonadi FM, Selden NR. 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Clin Neurol Neurosurg. 2014;125:182\u2013188."},{"key":"b9","series-title":"Clin Neurol Neurosurg","first-page":"1","article-title":"Comparison decompression by duraplasty or cerebellar tonsillectomy for Chiari malformation-I complicated with syringomyelia","volume":"176","author":"Jia C","year":"2019","unstructured":"Jia C, Li H, Wu J,  Comparison decompression by duraplasty or cerebellar tonsillectomy for Chiari malformation-I complicated with syringomyelia. Clin Neurol Neurosurg. 2019;176:1\u20137."},{"key":"b10","first-page":"147","article-title":"Evaluation of adult and pediatric Chiari type 1 malformation patients: do consensus documents fit everyday practice? Acta Neurochir Suppl","volume":"135","author":"Valentini LG","year":"2023","unstructured":"Valentini LG, Galbiati TF, Saletti V,  Evaluation of adult and pediatric Chiari type 1 malformation patients: do consensus documents fit everyday practice? 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Surg Neurol Int. 2013;4(1):26."},{"key":"b12","series-title":"World Neurosurg","first-page":"460","article-title":"Comparison of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I: a systematic review and meta-analysis","volume":"110","author":"Lin W","year":"2018","unstructured":"Lin W, Duan G, Xie J, Shao J, Wang Z, Jiao B. Comparison of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I: a systematic review and meta-analysis. World Neurosurg. 2018;110:460\u2013474.e5."},{"key":"b13","series-title":"World Neurosurg","first-page":"e465","article-title":"Comparison of clinical and radiographic outcomes for posterior fossa decompression with and without duraplasty for treatment of pediatric Chiari I malformation: a prospective study","volume":"110","author":"Jiang E","year":"2018","unstructured":"Jiang E, Sha S, Yuan X,  Comparison of clinical and radiographic outcomes for posterior fossa decompression with and without duraplasty for treatment of pediatric Chiari I malformation: a prospective study. World Neurosurg. 2018;110:e465\u2013e472."},{"key":"b14","series-title":"Acta Neurochir Suppl","first-page":"139","article-title":"Chiari malformation type 1 and syringomyelia: why do patients claim for international guidelines? 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