Tonkins Michael, Farooqi Naeem, Ahmed Rohan, Sinha Saurabh, Bhattacharyya Debapriya
a The Medical School , University of Sheffield , Sheffield , South Yorkshire , UK.
b Department of Neurosurgery , Queen Elizabeth Hospital , Birmingham , West Midlands , UK.
Br J Neurosurg. 2017 Aug;31(4):422-425. doi: 10.1080/02688697.2017.1297363. Epub 2017 Mar 2.
This study compares dural hitching to surgicel and tisseel overlay graft following craniocervical decompression and C1 laminectomy with simple durotomy for Chiari I malformation. Outcome measures were syrinx decompression, headache resolution and complication rates.
A retrospective analysis of case notes was conducted. Patients who had undergone craniocervical decompression (CCD) were grouped by method of dural closure. Outcomes compared were rates of syrinx decompression, headache resolution, and post-operative complications. Statistical analysis was conducted using SPSS v20.
We identified 32 adult patients for inclusion in this study. 53.1% (n = 17) had asyrinx, and 78.1% (n = 25) had a pre-operative headache. All were treated with suboccipital craniectomy, C1 laminectomy (with or without C2 laminectomy), and durotomy. The dura was either left open by dural hitching (n = 23) or closed with surgicel and tisseel overlay graft (n = 9). We found a statistically significant association between the method of dural closure and the rate of syrinx resolution. Resolution occurred in 91.7% (n = 11) of the hitching group, compared to 20.0% (n = 1) of the overlay graft group: Χ(1) = 5.6, p = .018. There were no statistically significant differences between the two groups in the rates of headache resolution or other complications.
In patients with symptomatic Chiari I malformation and associated syringomyelia, syrinx resolution is more likely if the dura is hitched open rather than closed bysurgicel and tisseel overlay graft after durotomy.
本研究比较了颅颈减压和C1椎板切除术后，Chiari I型畸形单纯硬脑膜切开时，硬脑膜悬吊术与速即纱和纤维蛋白胶覆盖移植术的效果。观察指标为空洞减压、头痛缓解情况和并发症发生率。
对病例记录进行回顾性分析。接受颅颈减压（CCD）的患者按硬脑膜闭合方法分组。比较的结果为空洞减压率、头痛缓解率和术后并发症。使用SPSS v20进行统计分析。
我们确定了32例成年患者纳入本研究。53.1%（n = 17）有脊髓空洞症，78.1%（n = 25）术前有头痛。所有患者均接受枕下颅骨切除术、C1椎板切除术（有或无C2椎板切除术）和硬脑膜切开术。硬脑膜要么通过硬脑膜悬吊术保持开放（n = 23），要么用速即纱和纤维蛋白胶覆盖移植术闭合（n = 9）。我们发现硬脑膜闭合方法与脊髓空洞症缓解率之间存在统计学显著关联。悬吊术组91.7%（n = 11）的患者空洞得到缓解，而覆盖移植术组为20.0%（n = 1）：Χ(1) = 5.6，p = 0.018。两组在头痛缓解率或其他并发症发生率方面无统计学显著差异。
对于有症状的Chiari I型畸形和相关脊髓空洞症的患者，硬脑膜切开术后，如果硬脑膜采用悬吊术保持开放而非用速即纱和纤维蛋白胶覆盖移植术闭合，则脊髓空洞症更有可能得到缓解。
