Mutchnick Ian S, Janjua Rashid M, Moeller Karen, Moriarty Thomas M
Department of Neurosurgery, University of Louisville, Kentucky, USA.
J Neurosurg Pediatr. 2010 May;5(5):474-8. doi: 10.3171/2010.1.PEDS09218.
The optimal surgical management of Chiari malformation (CM) is evolving. Evidence continues to accrue that supports decompression without duraplasty as an effective treatment to achieve symptomatic relief and anatomical decompression. The risks and benefits of this less invasive operation need to be weighed against decompression with duraplasty.
The authors performed a retrospective review of all CM decompressions from 2003 to 2007. All operations were performed by a single surgeon at a single institution. Data were analyzed for outcome, postoperative morbidity, and recurrence.
Of 121 unique patients, 56 underwent posterior fossa decompressions without duraplasty (PFD) and 64 patients underwent posterior fossa decompressions with duraplasty (PFDD). Of the 56 PFD patients, 7 (12.5%) needed a subsequent PFDD for symptomatic recurrence. Of the 64 patients who underwent a PFDD, 2 (3.1%) needed a repeated PFDD for symptomatic recurrence. Patients treated with PFDD had an average operative time of 201 minutes in contrast to 127 minutes for those who underwent PFD (p = 0.0001). Patients treated with PFDD had average hospital stays of 4.0 days, whereas that for patients treated with PFD was 2.7 days (p = 0.0001). While in the hospital, patients treated with PFDD used low-grade narcotics, intravenous narcotics, muscle relaxants, and antiemetic medications at statistically significant differing rates.
While PFD was associated with a higher rate of recurrent symptoms requiring repeated decompression, this may be justified by the significantly lower morbidity rate. Clearer delineation of the trade-off between morbidity and recurrence may be used to help patients and their families make decisions regarding care.
Chiari 畸形（CM）的最佳手术治疗方法正在不断发展。越来越多的证据支持，不进行硬脑膜成形术的减压术是实现症状缓解和解剖减压的有效治疗方法。这种侵入性较小的手术的风险和益处需要与硬脑膜成形术减压术进行权衡。
作者对2003年至2007年期间所有CM减压手术进行了回顾性研究。所有手术均由单一机构的一名外科医生进行。对结果、术后发病率和复发情况进行了数据分析。
在121例患者中，56例行后颅窝减压术且未行硬脑膜成形术（PFD），64例行后颅窝减压术并进行了硬脑膜成形术（PFDD）。在56例PFD患者中，7例（12.5%）因症状复发需要再次行PFDD。在64例行PFDD的患者中，2例（3.1%）因症状复发需要再次行PFDD。接受PFDD治疗的患者平均手术时间为201分钟，而行PFD的患者平均手术时间为127分钟（p = 0.0001）。接受PFDD治疗的患者平均住院时间为4.0天，而行PFD的患者平均住院时间为2.7天（p = 0.0001）。在住院期间，接受PFDD治疗的患者使用低级别麻醉剂、静脉麻醉剂、肌肉松弛剂和止吐药物的比例在统计学上有显著差异。
虽然PFD与需要再次减压的复发症状发生率较高相关，但这可能因发病率显著较低而合理。更清晰地描述发病率和复发之间的权衡，可用于帮助患者及其家属做出有关治疗的决策。
