Cools Michael J, Quinsey Carolyn S, Elton Scott W
J Neurosurg Pediatr. 2018 Jul;22(1):47-51. doi: 10.3171/2018.1.PEDS17670. Epub 2018 Apr 13.
OBJECTIVE The choice of graft material for duraplasty in decompressions of Chiari malformations remains a matter of debate. The authors present a detailed technique for harvesting ligamenta nuchae, as well as the clinical and radiographic outcomes of this technique, in a case series. METHODS The authors conducted a retrospective study evaluating the outcomes of Chiari malformation type I decompression and duraplasty in children aged 0-18 years at a single institution from 2013 to 2016. They collected both intraoperative and postoperative variables and compared them qualitatively to published data. RESULTS During the study period, the authors performed 25 Chiari malformation decompressions with ligamentum nuchae graft duraplasties. Of the 25 patients, 10 were females, and the mean age at surgery was 8.6 years (range 13 months to 18 years). The median operative time was 163 minutes (IQR 152-187 minutes), with approximately 10 minutes needed by a resident surgeon to harvest the graft. The mean length of stay was 3 nights (range 2-6 nights), and the mean follow-up was 12.6 months (range 0.5-43.5 months). One patient (4%) developed a CSF leak that was repaired using an oversewing patch. There were no postoperative pseudomeningoceles or infections. Of the 19 patients presenting with a syrinx, imaging showed improvement in 10 (53%) and 8 (42%) had stable syrinx size on imaging. Of 16 patients presenting with a symptomatic Chiari malformation, 14 (87.5%) experienced resolution of symptoms and in 1 (4%) symptoms remained the same. One patient (4%) presented with worsening syrinx and symptoms 1.5 months after initial surgery and underwent repeat decompression. CONCLUSIONS The authors describe a series of clinical and imaging outcomes of patients who underwent Chiari malformation decompression and duraplasty with a harvested ligamentum nuchae. The rates of postoperative CSF leak are similar to established techniques of autologous and artificial grafts, with similarly successful outcomes. Further study will be needed with larger patient cohorts to more directly compare duraplasty graft outcomes.
目的 在 Chiari 畸形减压术中硬膜成形术的移植材料选择仍存在争议。作者在一个病例系列中介绍了一种详细的采集项韧带的技术，以及该技术的临床和影像学结果。方法 作者进行了一项回顾性研究，评估 2013 年至 2016 年在单一机构中 0 - 18 岁儿童的 I 型 Chiari 畸形减压术和硬膜成形术的结果。他们收集了术中及术后变量，并与已发表的数据进行定性比较。结果 在研究期间，作者进行了 25 例采用项韧带移植硬膜成形术的 Chiari 畸形减压术。25 例患者中，10 例为女性，手术平均年龄为 8.6 岁（范围 13 个月至 18 岁）。中位手术时间为 163 分钟（四分位间距 152 - 187 分钟），住院医师采集移植材料大约需要 10 分钟。平均住院时间为 3 晚（范围 2 - 6 晚），平均随访时间为 12.6 个月（范围 0.5 - 43.5 个月）。1 例患者（4%）发生脑脊液漏，通过缝合修补进行了修复。术后无假性脑膜膨出或感染。在 19 例存在脊髓空洞症的患者中，影像学显示 10 例（53%）有所改善，8 例（42%）脊髓空洞症大小在影像学上保持稳定。在 16 例有症状性 Chiari 畸形的患者中，14 例（87.5%）症状得到缓解，1 例（4%）症状保持不变。1 例患者（4%）在初次手术后 1.5 个月出现脊髓空洞症和症状恶化，接受了再次减压。结论 作者描述了一系列接受 Chiari 畸形减压术和采用采集的项韧带进行硬膜成形术患者的临床和影像学结果。术后脑脊液漏发生率与自体和人工移植的既定技术相似，结果同样成功。需要对更大的患者队列进行进一步研究，以更直接地比较硬膜成形术移植材料的结果。
