Sanakoeva A V, Korshunov A E, Kadyrov Sh U, Khukhlaeva E A, Kushel' Yu V
Burdenko Neurosurgical Institute, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2017;81(3):48-57. doi: 10.17116/neiro201781348-56.
to develop the algorithm for defining the amount of posterior decompression of the craniovertebral junction in children with syringomyelia combined with Chiari-1 malformation.
Sixty eight children with syringomyelia and Chiari-1 malformation, under age of 18 years, underwent posterior decompression of the craniovertebral junction (PDCVJ) in the period from January 2001 to June 2016. Seven (10%) patients underwent extradural decompression (EDD), 16 (24%) patients underwent extra-arachnoid duraplasty (EAD), 25 (37%) patients underwent intra-arachnoid dissection (IAD) and duraplasty, and 20 (29%) patients underwent PDCVJ and placement of a fourth ventricle-subarachnoid shunt.
Clinical improvement occurred in 85% of patients, and stabilization was observed in 11% of patients. Syringomyelia regressed in 78% of cases. There were no complications associated with EDD; however, re-operation was required in 3 (43%) cases. In the case of EAD, treatment results were satisfactory in 11 (79%) patients; re-operation was required in 2 (12.5%) cases; there were no complications in the early postoperative period. The highest complication rate of 6 (30%) cases was associated with shunt placement and duraplasty. However, long-term results in this group of patients were satisfactory in 16 (94%) cases, and MRI-based positive changes were observed in 100% of cases.
According to our analysis, EAD is the method of choice for PDCVJ in children with syringomyelia and Chiari-1 malformation without myelopathy symptoms. In the presence of myelopathy symptoms, intra-arachnoid dissection (with or without shunting) is an acceptable alternative. To our opinion, the use of EDD in syringomyelia is unadvisable.
开发用于确定合并Chiari-1畸形的小儿脊髓空洞症患者颅颈交界区后路减压量的算法。
2001年1月至2016年6月期间，68例18岁以下合并脊髓空洞症和Chiari-1畸形的儿童接受了颅颈交界区后路减压术（PDCVJ）。7例（10%）患者接受了硬膜外减压（EDD），16例（24%）患者接受了蛛网膜外硬脑膜成形术（EAD），25例（37%）患者接受了蛛网膜内解剖（IAD）和硬脑膜成形术，20例（29%）患者接受了PDCVJ并置入第四脑室-蛛网膜下腔分流管。
85%的患者临床症状改善，11%的患者病情稳定。78%的病例脊髓空洞症消退。EDD未出现相关并发症；然而，3例（43%）患者需要再次手术。EAD治疗结果在11例（79%）患者中令人满意；2例（12.5%）患者需要再次手术；术后早期无并发症。6例（30%）患者的最高并发症发生率与分流管置入和硬脑膜成形术相关。然而，该组患者16例（94%）的长期结果令人满意，100%的病例观察到基于MRI的阳性变化。
根据我们的分析，对于无脊髓病症状的合并脊髓空洞症和Chiari-1畸形的儿童，EAD是PDCVJ的首选方法。存在脊髓病症状时，蛛网膜内解剖（伴或不伴分流）是一种可接受的替代方法。我们认为，在脊髓空洞症中使用EDD是不可取的。
