Kennedy Benjamin C, Nelp Taylor B, Kelly Kathleen M, Phan Michelle Q, Bruce Samuel S, McDowell Michael M, Feldstein Neil A, Anderson Richard C E
Department of Neurological Surgery and.
Department of Neurological Surgery, University of Pittsburgh, Pennsylvania.
J Neurosurg Pediatr. 2015 Nov;16(5):599-606. doi: 10.3171/2015.4.PEDS1572. Epub 2015 Aug 28.
OBJECT Chiari malformation Type I (CM-I) is associated with a syrinx in 25%-85% of patients. Although posterior fossa decompression (PFD) without dural opening is an accepted treatment option for children with symptomatic CM-I, many surgeons prefer to open the dura if a syrinx exists. The purpose of this study was to investigate the frequency and timing of syrinx resolution in children undergoing PFD without dural opening for CM-I. METHODS A retrospective review of 68 consecutive pediatric patients with CM-I and syringomyelia who underwent PFD without dural opening was conducted. Patient demographics, presenting symptoms and signs, radiographic findings, and intraoperative ultrasound and neuromonitoring findings were studied as well as the patients' clinical and radiographic follow-up. RESULTS During the mean radiographic follow-up period of 32 months, 70% of the syringes improved. Syrinx improvement occurred at a mean of 31 months postoperatively. All patients experienced symptom improvement within the 1st year, despite only 26% of patients showing radiographic improvement during that period. Patients presenting with sensory symptoms or motor weakness had a higher likelihood of having radiographic syrinx improvement postoperatively. CONCLUSIONS In children with CM-I and a syrinx undergoing PFD without dural opening, syrinx resolution occurs in approximately 70% of patients. Radiographic improvement of the syrinx is delayed, but this does not correlate temporally with symptom improvement. Sensory symptoms or motor weakness on presentation are associated with syrinx resolution after surgery.
I型Chiari畸形（CM-I）在25%-85%的患者中与脊髓空洞症相关。尽管对于有症状的CM-I患儿，不打开硬脑膜的后颅窝减压术（PFD）是一种可接受的治疗选择，但如果存在脊髓空洞症，许多外科医生更倾向于打开硬脑膜。本研究的目的是调查接受CM-I不打开硬脑膜的PFD的儿童脊髓空洞症消退的频率和时间。方法：对68例连续接受不打开硬脑膜的PFD治疗的CM-I和脊髓空洞症患儿进行回顾性研究。研究了患者的人口统计学资料、临床表现和体征、影像学检查结果、术中超声和神经监测结果以及患者的临床和影像学随访情况。结果：在平均32个月的影像学随访期内，70%的脊髓空洞症有所改善。脊髓空洞症改善平均发生在术后31个月。所有患者在第1年内症状均有改善，尽管在此期间只有26%的患者影像学有改善。出现感觉症状或运动无力的患者术后影像学脊髓空洞症改善的可能性更高。结论：在接受不打开硬脑膜的PFD治疗的CM-I和脊髓空洞症患儿中，约70%的患者脊髓空洞症消退。脊髓空洞症的影像学改善延迟，但这与症状改善在时间上不相关。出现感觉症状或运动无力与术后脊髓空洞症消退相关。
