Soleman Jehuda, Roth Jonathan, Bartoli Andrea, Rosenthal Daniel, Korn Akiva, Constantini Shlomi
Departments of Neurosurgery and Pediatric Neurosurgery, Sourasky Medical Center and Dana Children's Hospital Tel Aviv, Tel Aviv University, Tel Aviv, Israel.
Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.
World Neurosurg. 2017 Dec;108:836-843. doi: 10.1016/j.wneu.2017.08.002. Epub 2017 Aug 12.
Approximately 30% of patients treated with foramen magnum decompression (FMD) for Chiari I-associated syringomyelia will show persistence, recurrence, or progression of the syrinx.
This study evaluates the clinical and radiologic outcomes of syringo-subarachnoid shunt (SSS) as the treatment for persistent syringomyelia after FMD.
Data were collected retrospectively. The primary outcome measurement was neurologic function (assessed with the Modified Japanese Orthopedic Association [mJOA] scale). Secondary outcome measurements were surgical complications, reoperation rate, and syrinx status on magnetic resonance imaging (MRI).
Twenty-one patients (14 females [66.7%]) underwent SSS, either concurrent to the FMD or at a later stage. Two minor surgical complications were seen: a wound dehiscence and postoperative kyphosis, both requiring revision surgery. No major complication or mortality occurred. The median change in the mJOA score was an improvement of 3 out of a possible 17 points on the scale (mean follow-up, 24.9 months). Expressed as a percentage, overall improvement was 11.8% (95% confidence interval [CI], 5.9-17.6; P < 0.001). On postoperative MRI, shrinkage of the syrinx was seen in all but 1 patient in whom the syrinx remained unchanged. Expressed as percentage, the improvement of the syrinx surface was 76.3% (95% CI, 65.0-87.7; P < 0.001), and the improvement of syrinx span was 36.4% (95% CI, 21.8-50.9; P = 0.05).
SSS for persistent, recurrent, or increasing syrinx following FMD for Chiari I malformation is a safe and effective surgical treatment when performed selectively by an experienced neurosurgeon.
在接受枕大孔减压术（FMD）治疗Chiari I型相关脊髓空洞症的患者中，约30%会出现脊髓空洞持续存在、复发或进展。
本研究评估脊髓空洞-蛛网膜下腔分流术（SSS）作为FMD术后持续性脊髓空洞症治疗方法的临床和影像学效果。
回顾性收集数据。主要结局指标为神经功能（采用改良日本骨科协会[mJOA]量表评估）。次要结局指标为手术并发症、再次手术率以及磁共振成像（MRI）上的脊髓空洞状态。
21例患者（14例女性[66.7%]）接受了SSS，手术可与FMD同时进行，也可在后期进行。出现了2例轻微手术并发症：1例伤口裂开和1例术后脊柱后凸，均需再次手术。未发生重大并发症或死亡。mJOA评分的中位数变化为量表总分17分中提高了3分（平均随访24.9个月）。以百分比表示，总体改善率为11.8%（95%置信区间[CI]，5.9 - 17.6；P < 0.001）。术后MRI显示，除1例脊髓空洞无变化的患者外，其余患者的脊髓空洞均有缩小。以百分比表示，脊髓空洞表面积改善率为76.3%（95% CI，65.0 - 87.7；P < 0.001），脊髓空洞跨度改善率为36.4%（95% CI，21.8 - 50.9；P = 0.05）。
对于Chiari I畸形行FMD术后持续性、复发性或进展性脊髓空洞，由经验丰富的神经外科医生选择性地进行SSS是一种安全有效的手术治疗方法。
