Department of Neurosurgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
J Neurosurg Spine. 2012 Nov;17(5):381-7. doi: 10.3171/2012.7.SPINE12272. Epub 2012 Aug 31.
There is little information about the long-term effectiveness and complications following decompressive surgery for syringomyelia related to Chiari malformation Type I (CM-I).
Examining long-term clinical and radiological follow-up, the authors studied a mixed retrospective and prospective single-institution cohort of 109 consecutive surgically treated adult patients with syringomyelia and CM-I. All patients underwent a standardized surgical protocol: decompression of the craniocervical junction, arachnoid exploration, and shrinkage of the cerebellar tonsils. Factors predicting outcome were investigated.
The retrospective arm consisted of 41 cases treated between 1990 and 1994, and the prospective arm comprised 68 patients treated between 1994 and 2001. The mean overall age was 45.9 years, and 58.8% of the population was female. The median follow-up period was 12.7 years. The most frequent initial symptoms were pain and sensory and gait disturbances. There was no perioperative death or neurological deterioration. The comprehensive perioperative complication rate was approximately 11%, with 3 cases (2.7%) of CSF leakage. Regression analysis showed that the best combination of clinical and radiological outcome predictors was age and duration of symptoms. Clinical follow-up confirmed surgical result stability with clinical improvement of greater than 90% of the spinal and cranial manifestations over a long-term period. Two patients had radiological recurrences of syringomyelia without clinical signs 85 and 124 months after surgery.
Certain clinical predictors of poor clinical and radiological prognosis were identified-namely, age at time of surgery and symptom duration. The results of the study provide additional long-term data that support the effectiveness and safety of relieving CSF block at the craniocervical junction in CM-I-related syringomyelia.
有关 Chiari 畸形 I 型（CM-I）相关脊髓空洞症减压手术后的长期疗效和并发症的信息很少。
作者通过回顾性和前瞻性单中心队列研究，对 109 例连续接受手术治疗的成人脊髓空洞症伴 CM-I 患者的长期临床和影像学随访资料进行了研究。所有患者均采用标准化手术方案：颅颈交界减压、蛛网膜探查和小脑扁桃体缩小。研究了预测手术结果的因素。
回顾性臂由 1990 年至 1994 年治疗的 41 例病例组成，前瞻性臂由 1994 年至 2001 年治疗的 68 例患者组成。平均总体年龄为 45.9 岁，58.8%的患者为女性。中位随访时间为 12.7 年。最常见的首发症状为疼痛和感觉及步态障碍。无围手术期死亡或神经功能恶化。综合围手术期并发症发生率约为 11%，其中 3 例（2.7%）发生脑脊液漏。回归分析显示，临床和影像学结果预测因素的最佳组合是年龄和症状持续时间。临床随访证实，脊髓和颅神经表现的临床改善超过 90%，且在长期内手术效果稳定。2 例患者在术后 85 个月和 124 个月时出现脊髓空洞症影像学复发，但无临床症状。
确定了某些临床预后不良的预测因素，即手术时的年龄和症状持续时间。该研究结果提供了额外的长期数据，支持在 CM-I 相关脊髓空洞症中解除颅颈交界脑脊液阻塞的有效性和安全性。
