Endoscopic and Microsurgical Extradural Decompression in Chiari I Malformation: Operative Efficiency and Morbidity Optimization

Extradural posterior fossa decompression is widely used in symptomatic Chiari I malformation. Minimally invasive endoscopic approaches aim to reduce surgical morbidity while preserving decompression efficacy. The objective of this study is to compare operative efficiency and perioperative morbidity between endoscopic and conventional microsurgical extradural decompression techniques over an extended institutional experience. A retrospective comparative study of 25 consecutive adult patients undergoing extradural posterior fossa decompression for Chiari I malformation over an 8-year period was performed. Patients were divided into an endoscopic group (n = 13) and a microsurgical group (n = 12). Operative time, estimated blood loss, hospital stay, and perioperative complications were analyzed. The present cohort represents an extension of a previously published pilot series with additional patients and expanded perioperative evaluation. Mean operative time was comparable between endoscopic and microsurgical techniques (65 vs. 64 minutes). Estimated blood loss was lower in the endoscopic group (110 mL) compared with the microsurgical group (180 mL), representing a 39% reduction. Mean hospital stay was shorter in the endoscopic group (1.75 days) versus the microsurgical group (2.67 days). No cerebrospinal fluid leakage, reoperation, or neurological deterioration occurred in either group. Delayed wound healing was more frequent in the microsurgical group, whereas one case of delayed occipital neuralgia was observed in the endoscopic group. Endoscopic extradural decompression provides operative efficiency equivalent to the microsurgical approach while reducing intraoperative blood loss and shortening hospitalization. Technical refinement and standardization appear critical in optimizing surgical morbidity without compromising decompression safety.