Outcomes for various dural graft materials after posterior fossa decompression with duraplasty for Chiari malformation type I: a systematic review and meta-analysis

OBJECTIVE Posterior fossa decompression with duraplasty (PFDD) is often used for Chiari malformation type I (CM-I), but outcomes associated different dural graft materials are not well characterized. In this meta-analysis, the authors examined complication rates and after PFDD CM-I autografts four types of nonautologous grafts. METHODS A literature search numerous electronic databases (Ovid Medline, Embase, Scopus, Cochrane Database Systematic Reviews, Central Register Controlled Trials, Abstracts Reviews Effects, Health Technology Assessment Database, NHS Economic Evaluation ClinicalTrials.gov ) was performed to identify articles detailing complications PFDD. Whenever available, data were also extracted regarding need revision surgery, symptom changes PFDD, syrinx size All searches compliant Preferred Reporting Items Meta-Analyses (PRISMA), Institute Medicine, Standards Handbook Interventions , Peer Review Electronic Search Strategies guidelines. There no exclusion criteria based on patient age or presence absence syringomyelia. RESULTS The current evidence surrounding various found be low very quality. Twenty-seven studies included, encompassing 1461 patients. Five included: autograft (n = 404, 27.6%), synthetic 272, 18.6%), bovine pericardium 181, 12.4%), collagen-based 397, 27.2%), allograft 207, 14.2%). Autograft a significantly lower rate pseudomeningocele compared grafts, allografts, grafts in aggregate. lowest aseptic meningitis, infectious though these associations did reach statistical significance. No other comparisons yielded significant results. similar surgery produced improvements postoperative symptoms size. CONCLUSIONS material that most frequently had graft, allograft, materials. Autografts symptoms, Large prospective comparing needed accurately precisely characterize individual types.