{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:02:39Z","timestamp":1780401759405,"version":"3.54.1"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The optimal surgical technique for Chiari type I malformation (CM-I) remains debated, particularly in patients without syringomyelia. While duraplasty (DP+) may enhance radiological outcomes, it can carry higher complication risks. We compared clinical, radiological, and morphometric outcomes after suboccipital decompression with DP+ and without duraplasty (DP\u2212), with prespecified subgroup analyses by syringomyelia status. Materials and Methods: Ninety-three consecutive adult CM-I underwent DP\u2212 (n = 54) or DP+ (n = 39) between 2014 and 2022. Pre- and post-operative MRI and neurological evaluations were obtained at 1 year. Functional recovery was assessed using the Chicago Chiari Outcome Scale (CCOS). Clinical and radiological outcomes, complication rates, and subgroup results (with vs. without syringomyelia) were compared. Results: Overall clinical improvement was observed in 92.5% of patients (DP\u2212: 94.4%; DP+: 89.7%; p &gt; 0.05). Among patients without syringomyelia, clinical improvement remained high with DP\u2212. Radiological benefit\u2014including syrinx regression and mega cisterna magna formation\u2014was greater with DP+ (64.1% vs. 24.1%; p &lt; 0.001), but this did not translate into improved functional outcomes (p &gt; 0.05). Cerebellar slump occurred more often after DP+ (30.8% vs. 9.3%; p &lt; 0.05). Complication rates, particularly CSF-related events, were significantly higher with DP+ (17.9% vs. 3.7%, p = 0.032). Morphometric expansion of the foramen magnum did not correlate with functional outcomes. Conclusions: At 1-year follow-up, suboccipital decompression without duraplasty appears to provide comparable clinical improvement to DP+, with fewer complications, in selected CM-I patients without syringomyelia. Duraplasty offers radiological advantages, especially for syringomyelia, but at the cost of increased risk. Longer follow-up is necessary to determine the durability of these findings.<\/jats:p>","DOI":"10.3390\/medicina62061076","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T15:07:52Z","timestamp":1780326472000},"page":"1076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Duraplasty Versus Bony Decompression in Adult Chiari I: Comparative Clinical and Morphometric Analysis"],"prefix":"10.3390","volume":"62","author":[{"given":"Recai","family":"Engin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Samsun University, 55270 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8290-2216","authenticated-orcid":false,"given":"Fatih","family":"Tomakin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Samsun University, 55270 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0871-3977","authenticated-orcid":false,"given":"Hasan","family":"\u015eener","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ankara Gazi Mustafa Kemal Occupational and Environmental Diseases Hospital, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcrkan","family":"G\u00f6kalp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Ondokuz May\u0131s University, 55270 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4902-5298","authenticated-orcid":false,"given":"Vaner","family":"K\u00f6ksal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Samsun University, 55270 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015eevki Serhat","family":"Bayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Ondokuz May\u0131s University, 55270 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Aras","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Ondokuz May\u0131s University, 55270 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2146-3621","authenticated-orcid":false,"given":"Cengiz","family":"\u00c7okluk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Ondokuz May\u0131s University, 55270 Samsun, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/BRS.0000000000005288","article-title":"Indications for surgery and surgical options in Chiari malformation: WFNS spine committee recommendations","volume":"50","author":"Visocchi","year":"2025","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Blanque, R., Almaz\u00e1n-Soto, C., Piqueras-Sola, B., S\u00e1nchez-Garc\u00eda, J.C., Reinoso-Cobo, A., Menor-Rodr\u00edguez, M.J., and Cort\u00e9s-Mart\u00edn, J. (2023). Chiari syndrome: Advances in epidemiology and pathogenesis: A systematic review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206694"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"553","DOI":"10.3171\/jns.1999.91.4.0553","article-title":"Elucidating the pathophysiology of syringomyelia","volume":"91","author":"Heiss","year":"1999","journal-title":"J. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/j.1745-7599.2004.tb00384.x","article-title":"Prospective analysis of presenting symptoms among 265 patients with radiographie evidence of Chiari malformation type I with or without syringomyelia","volume":"16","author":"Mueller","year":"2004","journal-title":"J. Am. Acad. Nurse Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3171\/2014.12.PEDS14463","article-title":"Syrinx location and size according to etiology: Identification of Chiari-associated syrinx","volume":"16","author":"Strahle","year":"2015","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s00381-020-04667-7","article-title":"Comparison of surgical outcomes in patients with Chiari Type I malformation receiving posterior fossa decompression with and without duraplasty","volume":"36","author":"Butensky","year":"2020","journal-title":"Child's Nerv. Syst."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.clineuro.2014.07.027","article-title":"Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I","volume":"125","author":"Chotai","year":"2014","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_8","first-page":"419","article-title":"Comparison of the Surgical Results for Foramen Magnum Decompression with and without Duraplasty in Chiari Malformation Type 1","volume":"25","author":"Gurbuz","year":"2015","journal-title":"Turk. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.wneu.2017.10.161","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","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.wneu.2020.11.163","article-title":"Outcomes of dura splitting decompression versus posterior fossa decompression with duraplasty in the treatment of Chiari I malformation: A systematic review and meta-analysis","volume":"147","author":"Chang","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"439","DOI":"10.3171\/2017.6.PEDS16367","article-title":"The addition of duraplasty to posterior fossa decompression in the surgical treatment of pediatric Chiari malformation Type I: A systematic review and meta-analysis of surgical and performance outcomes","volume":"20","author":"Lu","year":"2017","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.wneu.2015.02.006","article-title":"Long-term outcomes after small-bone-window posterior fossa decompression and duraplasty in adults with Chiari malformation type I","volume":"84","author":"Deng","year":"2015","journal-title":"World Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3171\/2022.2.PEDS21446","article-title":"Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: A study from the Park-Reeves Syringomyelia Research Consortium","volume":"30","author":"Akbari","year":"2022","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.wneu.2021.05.124","article-title":"Comparative assessment of three posterior fossa decompression techniques and evaluation of the evidence supporting the efficacy of syrinx shunting and filum terminale sectioning in Chiari malformation type I. A Syst. review and network meta-analysis","volume":"152","author":"Antkowiak","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00701-020-04403-9","article-title":"Posterior fossa decompression with duraplasty in Chiari malformation type 1: A systematic review and meta-analysis","volume":"163","author":"Tam","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1007\/s10072-021-05347-3","article-title":"Diagnosis and treatment of Chiari malformation and syringomyelia in adults: International consensus document","volume":"43","author":"Ciaramitaro","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"662","DOI":"10.4103\/0028-3886.263222","article-title":"Chiari I malformation: Surgical considerations","volume":"67","author":"Mohanty","year":"2019","journal-title":"Neurol. India"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.wneu.2010.09.005","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","year":"2011","journal-title":"World Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00701-020-04631-z","article-title":"Symptom outcome after craniovertebral decompression for Chiari type 1 malformation without syringomyelia","volume":"163","author":"Pepper","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_20","first-page":"364","article-title":"Long-term outcome of surgical treatment of Chiari malformation without syringomyelia","volume":"64","author":"Giammattei","year":"2017","journal-title":"J. Neurosurg. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s10072-017-2950-5","article-title":"Chiari malformation-related headache: Outcome after surgical treatment","volume":"38","author":"Beretta","year":"2017","journal-title":"Neurol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s10143-025-03640-9","article-title":"Clinical outcome of different surgical approaches for symptomatic Chiari malformation without syringomyelia: A 13-year retrospective study","volume":"48","author":"Yu","year":"2025","journal-title":"Neurosurg. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3171\/2010.12.PEDS10379","article-title":"Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type","volume":"7","author":"Tubbs","year":"2011","journal-title":"I. J. Neurosurg. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"381","DOI":"10.3171\/2012.7.SPINE12272","article-title":"Long-term results after posterior fossa decompression in syringomyelia with adult Chiari Type I malformation","volume":"17","author":"Alfieri","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2891","DOI":"10.1007\/s00381-021-05280-y","article-title":"Long-term outcomes of posterior fossa decompression for Chiari malformation type 1: Which patients are most prone to failure?","volume":"37","author":"Mozaffari","year":"2021","journal-title":"Child's Nerv. Syst."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"629","DOI":"10.3171\/2020.1.PEDS19493","article-title":"Factors associated with syrinx size in pediatric patients treated for Chiari malformation type I and syringomyelia: A study from the Park-Reeves Syringomyelia Research Consortium","volume":"25","author":"Hale","year":"2020","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1007\/s00701-024-06332-3","article-title":"Long-term outcomes following posterior fossa decompression in pediatric patients with Chiari malformation type 1, a population-based cohort study","volume":"166","author":"Sandvik","year":"2024","journal-title":"Acta Neurochir."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10072-026-08820-z","article-title":"MRI-morphometric characterization of Chiari malformation types 0 and 1 with syringomyelia: Implications for diagnosis and pathogenesis","volume":"47","author":"Bogdanov","year":"2026","journal-title":"Neurol. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Massimi, L., Frassanito, P., Chieffo, D., Tamburrini, G., and Caldarelli, M. (2019). Bony decompression for Chiari malformation type I: Long-term follow-up. New Trends in Craniovertebral Junction Surgery: Experimental and Clinical Updates for a New State of Art, Springer.","DOI":"10.1007\/978-3-319-62515-7_17"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s00701-024-05999-y","article-title":"Long-term outcome of operated Chiari I patients between 2005 and 2020 in Eastern Finland","volume":"166","author":"Moniruzzaman","year":"2024","journal-title":"Acta Neurochir."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:06:50Z","timestamp":1780398410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medicina62061076"],"URL":"https:\/\/doi.org\/10.3390\/medicina62061076","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}