1. The duraplasty is the general procedure for dealing with the dura mater during the Chiari decompression surgery. Since duraplasty is most often used by surgeons, the possible negative outcomes are taken into consideration and watched for closely after the decompression surgery and can be treated as necessary with the appropriate antibiotics and post procedures. Another positive to duraplasty is the lower rate for reoperation due to adequate and appropriate decompression. From a personal account, I received the boney decompression with duraplasty, my dura was replaced with a synthetic dura membrane. My complications post surgery included aseptic meningitis, and cerebrospinal fluid leakage and build up on the brain. But I would really rather not have to have another surgery, or have a part of my brain shrunk or removed. And my symptoms are now much less severe. On the other hand, the duraplasty procedure performed for the Chiari decompression does have a high complication rate. Some of these complications include but are not restricted to: superficial wound infections, bacterial meningitis, aseptic meningitis, cerebrospinal fluid leakage (between layers of the dura, or onto the brain itself, and rarely into the blood), and pseudomeningocele formation. Thus recent studies have been performed on the use of dura-splitting, which may not necessarily allow for the appropriate decompression. And in most Chiari cases, the dura is scarred and needs to be removed. Duraplasty for Chiari Decompression? Chiari Malformation is a rare neurological disorder in which the cerebella tonsils descend through the foramen magnum causing headaches in mild cases (Chiari I) and paralysis in severe cases (Chiari IV). Essentially the back of the brain, or cerebellum, presses out of the opening in the back of the skull and pinches off the spinal cord. If the only symptom a person has are headaches which are not severe, surgery is not recommended and the condition can be taken care of with pain medications. There are two types of decompression surgery to help with symptoms of Chiari: Boney decompression in which part of the lower skull is cut off and sometimes pieces of the first and second cervical vertebrae are removed; or tonsil resection and/or shrinkage, by applying bipolar electro cautery or completely cutting out the tonsils (the repercussions of this particular procedure are still unknown because the use of the cerebella tonsils is unknown to neurologists). In both types of Chiari decompression there is always the question of how to treat the dura mater. The dura mater is a dense fibrous tissue that surrounds the brain and spinal cord and is responsible for keeping in the cerebrospinal fluid. Some neurosurgeons completely remove it and replace it with bovine pericardium or synthetic materials (generally collagen based) which is called duraplasty, others only remove the outer layer leaving the lower layer as the only mater which is believed to be flexible enough to still allow cerebrospinal fluids to flow freely, this procedure is called dura-splitting. For both procedures there are pros and cons, which is why the decision is generally up to the surgeon, the patient, and/or the parents of the patient. Abla, A.: et al. Comparison of dural grafts in Chiari decompression surgery: Review of the literature. J Craniovert Jun Spine 2010;1:29-37, Labuda, Rick. C&S Patient Education Foundation: Conquer Chiari. Mechanical study supports dura splitting technique. 2010.,

2. Citations Abla, A.; et al. Comparison of dural grafts in Chiari decompression surgery: Review of the literature. J Craniovert Jun Spine 2010;1:29- 37 Labuda, Rick. Mechanical study supports dura splitting technique. 2010. C&S Patient Education Foundation: Conquer Chiari. Chiari malformation and beyond: Chiari malformation. 2010. The Wisconsin Chiari center. Types of operations for Chiari I. 2010. Chiari and Syringomyelia foundation. Come revoke, relive the moments you have lost. 2005. Chiari malformation (CMs). Depression-guide.com. Department of neurological surgery: Chiari malformation.2009. Columbia University medical center.