Effect of symptomatic pseudomeningocele on improvement in pain, disability, and quality of life following suboccipital decompression for adult Chiari malformation type I

• Published in: Journal of neurosurgery Vol. 119; no. 5; pp. 1159 - 1165
• Main Authors: Parker, Scott L, Godil, Saniya S, Zuckerman, Scott L, Mendenhall, Stephen K, Tulipan, Noel B, McGirt, Matthew J
• Format: Journal Article
• Language: English
• Published: United States 01-11-2013
• Subjects: Adult; Arnold-Chiari Malformation - surgery; Decompression, Surgical - adverse effects; Decompression, Surgical - methods; Disability Evaluation; Female; Follow-Up Studies; Humans; Male; Meningocele - etiology; Middle Aged; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Occipital Bone - surgery; Postoperative Complications - pathology; Postoperative Complications - physiopathology; Postoperative Complications - psychology; Quality of Life; Treatment Outcome
• ISSN: 1933-0693
• DOI: 10.3171/2013.8.jns122106

Suboccipital decompression is a common procedure for patients with Chiari malformation Type I (CMI). Published studies have reported complication rates ranging from 3% to 40%, with pseudomeningocele being one of the most common complications. To date, there are no studies assessing the effect of this complication on long-term outcome. Therefore, the authors set out to assess the effect of symptomatic pseudomeningocele on patient outcomes following suboccipital decompression for CM-I.
The study comprised 50 adult patients with CM-I who underwent suboccipital craniectomy and C-1 laminectomy with or without duraplasty. Clinical presentation, radiological studies, operative variables, and complications were assessed for each case. Baseline and 1-year postoperative patient-reported outcomes were assessed to determine improvement in pain, disability, and quality of life. The extent of improvement was compared for patients with and without development of a postoperative symptomatic pseudomeningocele.
A symptomatic pseudomeningocele developed postoperatively in 9 patients (18%). There was no difference with regard to clinical, radiological, or operative variables for patients with or without a postoperative pseudomeningocele. Patients without a pseudomeningocele had significant improvement in all 9 patient-reported outcome measures assessed. On the other hand, patients with pseudomeningocele only had significant improvement in headache (as measured on the Numeric Rating Scale) and headache-related disability (as measured on the Headache Disability Index) but no improvement in quality of life. Twenty-nine (71%) of 41 patients without a pseudomeningocele reported improvement in health status postoperatively compared with only 3 (33%) of 9 patients with a postoperative pseudomeningocele (p = 0.05).
Surgical management of CM-I in adults provides significant and sustained improvement in pain, disability, general health, and quality of life. Development of a postoperative symptomatic pseudomeningocele has lingering effects at 1 year, and it significantly diminishes the overall benefit of suboccipital decompression for CM-related symptoms. Further research is needed to accurately predict which patients may benefit from decompression alone without duraplasty.