Navarro Ramon, Olavarria Greg, Seshadri Roopa, Gonzales-Portillo Gabriel, McLone David G, Tomita Tadanori
Division of Pediatric Neurosurgery, Children's Memorial Hospital, Northwestern University Medical School, 2300 Children's Plaza, Box #28, Chicago, IL 60614, USA.
Childs Nerv Syst. 2004 May;20(5):349-56. doi: 10.1007/s00381-003-0883-1. Epub 2004 Mar 12.
An increasing number of children with Chiari I malformations are coming to the attention of neurosurgeons today, although a consensus on the surgical approach to these lesions has yet to be found.
We present a retrospective analysis of posterior fossa decompression (PFD) performed at our institution on 96 patients from 1989 to 2001. Statistical analyses based on clinical and radiographic presentation and the types of surgical procedures used formed the basis for our review.
Most of the patients with hydromyelia underwent duraplasty procedures with or without tonsillar manipulation. In contrast, most patients without hydromyelia underwent bony decompression with dural scoring and intraoperative ultrasound. PFD with bony decompression and dural scoring showed a 72% success rate, compared with 68% for duraplasty. Dural opening was not more likely to improve or arrest hydromyelia. The group subjected to duraplasty, however, had a significantly higher complication rate. Patients under the age of 8 fared better than their older counterparts.
Overall, we favor a tailored posterior fossa craniectomy with dural scoring as the initial surgical procedure in children with Chiari I malformation with or without a syrinx. This less invasive approach minimizes complications associated with dural opening and offers comparable success rates.
如今，越来越多患有Chiari I型畸形的儿童引起了神经外科医生的关注，尽管对于这些病变的手术方法尚未达成共识。
我们对1989年至2001年在本机构对96例患者进行的后颅窝减压术（PFD）进行了回顾性分析。基于临床和影像学表现以及所采用的手术程序类型进行的统计分析构成了我们回顾的基础。
大多数患有脊髓空洞症的患者接受了硬脑膜成形术，无论是否进行扁桃体操作。相比之下，大多数没有脊髓空洞症的患者接受了骨减压、硬脑膜划痕和术中超声检查。进行骨减压和硬脑膜划痕的PFD成功率为72%，而硬脑膜成形术的成功率为68%。打开硬脑膜并不更有可能改善或阻止脊髓空洞症。然而，接受硬脑膜成形术的组并发症发生率明显更高。8岁以下的患者比年龄较大的患者情况更好。
总体而言，我们倾向于采用定制的后颅窝颅骨切除术并进行硬脑膜划痕，作为患有或不患有脊髓空洞症的Chiari I型畸形儿童的初始手术方法。这种侵入性较小的方法可将与打开硬脑膜相关的并发症降至最低，并提供相当的成功率。
