Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
J Neurosurg. 2013 Nov;119(5):1159-65. doi: 10.3171/2013.8.JNS122106. Epub 2013 Sep 6.
Suboccipital decompression is a common procedure for patients with Chiari malformation Type I (CMI). Published studies have reported complication rates ranging from 3% to 40%, with pseudomeningocele being one of the most common complications. To date, there are no studies assessing the effect of this complication on long-term outcome. Therefore, the authors set out to assess the effect of symptomatic pseudomeningocele on patient outcomes following suboccipital decompression for CM-I.
The study comprised 50 adult patients with CM-I who underwent suboccipital craniectomy and C-1 laminectomy with or without duraplasty. Clinical presentation, radiological studies, operative variables, and complications were assessed for each case. Baseline and 1-year postoperative patient-reported outcomes were assessed to determine improvement in pain, disability, and quality of life. The extent of improvement was compared for patients with and without development of a postoperative symptomatic pseudomeningocele.
A symptomatic pseudomeningocele developed postoperatively in 9 patients (18%). There was no difference with regard to clinical, radiological, or operative variables for patients with or without a postoperative pseudomeningocele. Patients without a pseudomeningocele had significant improvement in all 9 patient-reported outcome measures assessed. On the other hand, patients with pseudomeningocele only had significant improvement in headache (as measured on the Numeric Rating Scale) and headache-related disability (as measured on the Headache Disability Index) but no improvement in quality of life. Twenty-nine (71%) of 41 patients without a pseudomeningocele reported improvement in health status postoperatively compared with only 3 (33%) of 9 patients with a postoperative pseudomeningocele (p = 0.05).
Surgical management of CM-I in adults provides significant and sustained improvement in pain, disability, general health, and quality of life. Development of a postoperative symptomatic pseudomeningocele has lingering effects at 1 year, and it significantly diminishes the overall benefit of suboccipital decompression for CM-related symptoms. Further research is needed to accurately predict which patients may benefit from decompression alone without duraplasty.
后颅窝减压术是 Chiari 畸形 I 型（CMI）患者的常见手术。已发表的研究报告的并发症发生率为 3%至 40%，其中假性脑脊膜膨出是最常见的并发症之一。迄今为止，尚无研究评估该并发症对长期结果的影响。因此，作者旨在评估后颅窝减压术后症状性假性脑脊膜膨出对 CMI-I 患者结局的影响。
该研究纳入了 50 例接受后颅窝减压术和 C1 椎板切除术（伴或不伴硬脑膜成形术）的 CMI-I 成年患者。评估了每个病例的临床表现、影像学研究、手术变量和并发症。评估了基线和术后 1 年的患者报告结局，以确定疼痛、残疾和生活质量的改善情况。比较了发生和未发生术后症状性假性脑脊膜膨出的患者的改善程度。
9 例（18%）患者术后出现症状性假性脑脊膜膨出。有无术后假性脑脊膜膨出的患者在临床、影像学或手术变量方面无差异。无假性脑脊膜膨出的患者在所有 9 项患者报告结局测量指标中均有显著改善。另一方面，假性脑脊膜膨出患者仅在头痛（数字评分量表）和与头痛相关的残疾（头痛残疾指数）方面有显著改善，但生活质量没有改善。41 例无假性脑脊膜膨出的患者中，29 例（71%）报告术后健康状况改善，而 9 例有术后假性脑脊膜膨出的患者中仅 3 例（33%）报告改善（p = 0.05）。
成人 CMI 的手术治疗可显著且持续地改善疼痛、残疾、一般健康状况和生活质量。术后出现症状性假性脑脊膜膨出会持续 1 年，并显著降低后颅窝减压术对与 CMI 相关的症状的整体获益。需要进一步研究以准确预测哪些患者可能受益于单纯减压而无需硬脑膜成形术。
