Xie Ding-ding, Zhu Ze-zhang, Qiu Yong, Sha Shi-fu, Jiang Long, Qian Bang-ping, Sun Xu, Yan Huang
Department of Spinal Surgery, Nanjing Drum Tower Clinical, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Department of Spinal Surgery, Nanjing Drum Tower Clinical, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China. Email:
Zhonghua Wai Ke Za Zhi. 2013 Oct;51(10):895-9.
To evaluate the changes of the position of medulla oblongata and cerebellum following posterior fossa decompression (PFD), and to investigate their influences on the prognosis of the syringomyelia in adolescents with Chiari malformation (CM).
A retrospective review was performed on all CM patients between September 2006 and September 2011. A subset of 46 patients, including 25 male and 21 female patients, was finally enrolled according to the inclusion criteria. The initial age and duration of follow-up averaged 13.9 years (range, 10-17 years) and 13 months (range, 6-52 months), respectively. On mid-sagittal MRI, the following parameters were evaluated pre- and postoperatively (follow-up ≥ 6 months): the longitudinal and transverse position of bulbopontine sulcus, the fourth ventricle vertex, the lower extreme of cerebella tonsil, the cervico-medullary angle, the maximal syrinx/cord(S/C) ratio and the syrinx length. Changes in these parameters were analysed using the paired samples t test, and for these reaching statistical significances, an additional bivariate correlation analysis was performed to investigate their relation with syrinx resolution.
At the latest follow-up, upward shifting of the bulbopontine sulcus was observed in 31 patients(67.4%), with upward shifting of the lower extreme of cerebella tonsil presenting in 35 patients(76.0%). The maximal S/C ratio and the syrinx length were significantly improved postoperatively (t = 7.114 and 7.816, P = 0.000).Significant resolution of the syrinx was demonstrated in 40 patients(86.9%), and more specifically, the average improvement rates of the maximal S/C ratio and the syrinx length were 32% ± 30%and 43% ± 33%, respectively. In addition, the bivariate correlation analysis revealed that syrinx resolution was significantly correlated with the upward shifting of the bulbopontine sulcus (r = 0.332, P = 0.027) and lower extreme of cerebella (r = 0.298, P = 0.044) .
The upward shifting of the bulbopontine sulcus and the lower extreme of cerebella tonsil might be implicated in the mechanisms of postoperative syrinx resolution.
评估后颅窝减压术（PFD）后脑延髓和小脑位置的变化，并探讨其对青少年Chiari畸形（CM）合并脊髓空洞症预后的影响。
对2006年9月至2011年9月期间所有CM患者进行回顾性研究。根据纳入标准，最终纳入46例患者，其中男性25例，女性21例。初始年龄和随访时间平均分别为13.9岁（范围10 - 17岁）和13个月（范围6 - 52个月）。在矢状位MRI上，术前及术后（随访≥6个月）评估以下参数：延髓脑桥沟的纵向和横向位置、第四脑室顶点、小脑扁桃体下端、颈髓角、最大空洞/脊髓（S/C）比值及空洞长度。使用配对样本t检验分析这些参数的变化，对于具有统计学意义的参数，进一步进行双变量相关分析以研究它们与空洞消退的关系。
在最近一次随访时，31例患者（67.4%）观察到延髓脑桥沟上移，35例患者（76.0%）出现小脑扁桃体下端上移。术后最大S/C比值和空洞长度显著改善（t = 7.114和7.816，P = 0.000）。40例患者（86.9%）空洞明显消退，具体而言，最大S/C比值和空洞长度的平均改善率分别为32%±30%和43%±33%。此外，双变量相关分析显示空洞消退与延髓脑桥沟上移（r = 0.332，P = 0.027）和小脑下端上移（r = 0.298，P = 0.044）显著相关。
延髓脑桥沟和小脑扁桃体下端上移可能与术后空洞消退机制有关。
