000			03084nam a2200373 4500
001			ESSALUD
005			20260902145039.0
007			ta
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040			_aBMG
041			_aeng
100			_aLimbrick, David D. _eAutor _954408
245			_aDecompression with or without Duraplasty for Chiari I and Syringomyelia
300			_apáginas: 2015-2025
520			_aBackground: In children with Chiari type I malformation and syringomyelia, neurosurgical posterior fossa decompression (PFD) provides clinical improvement, but whether duraplasty (incising the dura and placing a dural graft) improves outcomes is unclear. Methods: We conducted a multicenter, cluster-randomized, controlled trial of PFD with duraplasty (PFD-D) as compared with PFD alone. Persons 21 years of age or younger with cerebellar tonsillar ectopia of at least 5 mm and a maximum syrinx diameter of 3.0 to 9.9 mm were enrolled at 38 centers. Centers were cluster-randomized: all the participants within each center underwent the same intervention. The primary outcome was surgical complications within 6 months. Secondary outcomes were clinical improvement, syrinx reduction, and repeat decompression at 10 to 24 months and the change in overall health-related quality of life at 6 to 24 months. Results: A total of 162 participants were included in the trial, of whom 78 were assigned to undergo PFD-D and 84 to undergo PFD alone. The percentage of participants with complications within 6 months was 14% with PFD-D and 6% with PFD (adjusted odds ratio, 2.59; 95% confidence interval [CI], 0.86 to 7.84; P=0.11). At 24 months, the percentage of participants with clinical improvement was 58% with PFD-D and 46% with PFD; the mean (±SD) syrinx reduction was 3.08±2.33 mm and 1.22±1.79 mm, respectively; and the percentage of participants with repeat decompression was 3% and 14%. Changes in health-related quality of life were similar in the two groups. Conclusions: The percentage of participants with surgical complications did not differ significantly between those who underwent PFD-D and those who underwent PFD alone. Larger trials are needed to determine the relative benefits and risks of these two procedures.
650			_aENFERMEDADES INFANTILES _953890
650			_aMEDICINA CLÍNICA HOSPITALARIA _953754
650			_aORTOPEDIA GENERAL _954409
650			_aPEDIATRÍA GENERAL _954247
650			_aTRASTORNOS DE LA COLUMNA VERTEBRAL _954410
650			_aNEUROLOGÍA
650			_aNEUROCIRUGÍA GENERAL _953668
700			_aShannon, Chevis N. _954411
700			_aBayman, Emine O. _954412
700			_aMeehan, Thanda _954413
700			_aKallem, Marisa _954414
700			_aAckerman, Laurie L. _954415
700			_aAdelson, P. David _954416
700			_aAhmed, Raheel _954417
700			_aAlbert, Gregory _954418
700			_aAldana, Philipp R. _954419
773	0		_022717 _922665 _dMassachusetts NEJM Group _oNEJM013 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-08-28 _zsqb
999			_c22888 _d22888