Chotai Silky, Kshettry Varun R, Lamki Tariq, Ammirati Mario
Department of Neurological Surgery, Ohio State University Medical Center, Columbus, USA.
Department of Neurological Surgery, Ohio State University Medical Center, Columbus, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, USA.
Clin Neurol Neurosurg. 2014 May;120:129-35. doi: 10.1016/j.clineuro.2014.02.016. Epub 2014 Feb 25.
Posterior fossa decompression with or without duraplasty is the most common surgical technique employed to treat Chiari-1 malformation (CM). There is considerable debate as to whether large versus small craniectomy leads to better outcomes. The aim of this study was to report our technique and outcomes using a wide suboccipital craniectomy with arachnoid sparing duraplasty. A retrospective review of medical records for symptomatic CM patients with and without syringomyelia was conducted. Follow-up results were obtained via telephone interviews and medical records. Favorable outcome was defined as improvement in self-rated overall status and/or improvement in Glasgow outcome scale (GOS) score. Poor outcome was defined as worsening of either self-rated overall status or GOS score postoperatively. Mean age of 28 female and 2 male patients was 36.6 years (range 20-67). Seven (23%) patients had syringomyelia, one (3%) had hydrocephalus, and two (7%) had prior surgery. Mean follow-up was 27.5 months (range 5-72). Favorable, acceptable, and poor outcomes were achieved in 90%, 3%, and 7% respectively. 87% of respondents indicated they would choose surgery if they had to make a decision again. The most common complication was pseudomeningocele (23%) followed by CSF leak (10%) and meningitis (7%). One transient (3%) neurologic complication occurred. Surgical technique of wide bony decompression of posterior fossa with arachnoid sparing pericranial duraplasty demonstrates favorable outcomes with an acceptable complication rate for patients with symptomatic CM. Prior CM decompression and non-autologous dural graft were associated with poor outcome. Further study is needed to determine the optimal extent of bony decompression.
后颅窝减压术伴或不伴硬脑膜成形术是治疗Chiari-1畸形（CM）最常用的外科技术。关于大骨瓣开颅术与小骨瓣开颅术哪种能带来更好的治疗效果，存在相当大的争议。本研究的目的是报告我们采用保留蛛网膜的硬脑膜成形术进行广泛枕下开颅术的技术及治疗效果。对有症状的CM患者（伴或不伴脊髓空洞症）的病历进行了回顾性分析。通过电话访谈和病历获取随访结果。良好的治疗效果定义为自我评定的总体状况改善和/或格拉斯哥预后评分（GOS）提高。不良的治疗效果定义为术后自我评定的总体状况或GOS评分恶化。28例女性和2例男性患者的平均年龄为36.6岁（范围20 - 67岁）。7例（23%）患者有脊髓空洞症，1例（3%）有脑积水，2例（7%）曾接受过手术。平均随访时间为27.5个月（范围5 - 72个月）。分别有90%、3%和7%的患者取得了良好、尚可和不良的治疗效果。87%的受访者表示，如果必须再次做出决定，他们会选择手术。最常见的并发症是假性脑膜膨出（23%），其次是脑脊液漏（10%）和脑膜炎（7%）。发生了1例短暂性（3%）神经并发症。采用保留蛛网膜的颅骨膜硬脑膜成形术进行后颅窝广泛骨性减压的外科技术，对于有症状的CM患者显示出良好的治疗效果，并发症发生率可接受。既往CM减压术和非自体硬脑膜移植与不良治疗效果相关。需要进一步研究以确定骨性减压的最佳范围。
