Koehler J, Eggers J, Schwarz M, Faldum A
Abteilung für Neurologie, Asklepios Klinik Nord, Tangstedter Landstrasse 400, Hamburg, Germany.
Nervenarzt. 2010 Feb;81(2):212-7. doi: 10.1007/s00115-009-2905-z.
In about 20% of patients with Chiari II malformation brainstem signs and symptoms occur. Ventilatory dysfunction is the main cause of death in these patients. The indication for craniocervical decompression is based on clinical examination because supporting electrophysiological or radiological methods were lacking.
In a prospective study the clinical courses of 106 patients were documented during a 3-year period. In addition brainstem diagnostic procedures using the masseter reflex (MR), blink reflex (BR) and early auditory evoked potentials (EAEP) were done. Based on the model of binary logistic regression the odds ratio (OR) of progression over time was calculated.
The combination of MR and late BR components showed the highest correlation with clinical findings (OR: 23). The highest predictive value regarding clinical progression over a 3-year period was shown by the combined evaluation of MR, late BR components and EAEP interpeak latency I-V (OR: 17.6). Signs and symptoms had no predictive value.
Combined brainstem reflex recordings (MR and late BR components) support the clinical examination. To evaluate the long-term prognosis brainstem reflexes and EAEP recordings should be used.
在约20%的Chiari II型畸形患者中会出现脑干体征和症状。通气功能障碍是这些患者的主要死因。颅颈减压的指征基于临床检查，因为缺乏辅助的电生理或放射学方法。
在一项前瞻性研究中，记录了106例患者在3年期间的临床病程。此外，还采用咬肌反射（MR）、瞬目反射（BR）和早期听觉诱发电位（EAEP）进行脑干诊断。基于二元逻辑回归模型计算随时间进展的比值比（OR）。
MR与BR晚期成分的组合与临床发现的相关性最高（OR：23）。MR、BR晚期成分和EAEP I-V峰间期的联合评估显示出对3年期间临床进展的最高预测价值（OR：17.6）。体征和症状无预测价值。
联合脑干反射记录（MR和BR晚期成分）有助于临床检查。为评估长期预后，应使用脑干反射和EAEP记录。
