Kim Irene, Hopson Betsy, Aban Inmaculada, Rizk Elias B, Dias Mark S, Bowman Robin, Ackerman Laurie L, Partington Michael D, Castillo Heidi, Castillo Jonathan, Peterson Paula R, Blount Jeffrey P, Rocque Brandon G
1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
2Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham.
J Neurosurg Pediatr. 2018 Dec 1;22(6):652-658. doi: 10.3171/2018.5.PEDS18160. Epub 2018 Aug 24.
OBJECTIVEThe purpose of this study was to determine the rate of decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry (NSBPR). In addition, the authors explored the variation in rates of Chiari II decompression across NSBPR institutions, examined the relationship between Chiari II decompression and functional lesion level of the myelomeningocele, age, and need for tracheostomy, and they evaluated for temporal trends in rates of Chiari II decompression.METHODSThe authors queried the NSBPR to identify all individuals with myelomeningocele between 2009 and 2015. Among these patients, they identified individuals who had undergone at least 1 Chiari II decompression as well as those who had undergone tracheostomy. For each participating NSBPR institution, the authors calculated the proportion of patients enrolled at that site who underwent Chiari II decompression. Logistic regression was performed to analyze the relationship between Chiari II decompression, functional lesion level, age at decompression, and history of tracheostomy.RESULTSOf 4448 individuals with myelomeningocele identified from 26 institutions, 407 (9.15%) had undergone at least 1 Chiari II decompression. Fifty-one patients had undergone tracheostomy. Logistic regression demonstrated a statistically significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, with a more rostral lesion level associated with a higher likelihood of posterior fossa decompression. Similarly, children born before 2005 and those with history of tracheostomy had a significantly higher likelihood of Chiari II decompression. There was no association between functional lesion level and need for tracheostomy. However, among those children who underwent Chiari II decompression, the likelihood of also undergoing tracheostomy increased significantly with younger age at decompression.CONCLUSIONSThe rate of Chiari II decompression in patients with myelomeningocele in the NSBPR is consistent with that in previously published literature. There is a significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, which has not previously been reported. Younger children who undergo Chiari II decompression are more likely to have undergone tracheostomy. There appears to be a shift away from Chiari II decompression, as children born before 2005 were more likely to undergo Chiari II decompression than those born in 2005 or later.
目的
本研究的目的是确定国家脊柱裂患者登记处（NSBPR）中患有脊髓脊膜膨出的个体的Chiari II型畸形减压率。此外，作者探讨了NSBPR各机构间Chiari II型减压率的差异，研究了Chiari II型减压与脊髓脊膜膨出的功能病变水平、年龄及气管造口术需求之间的关系，并评估了Chiari II型减压率的时间趋势。
方法
作者查询NSBPR以识别2009年至2015年间所有患有脊髓脊膜膨出的个体。在这些患者中，他们确定了至少接受过1次Chiari II型减压的个体以及接受过气管造口术的个体。对于每个参与的NSBPR机构，作者计算了在该机构登记的接受Chiari II型减压的患者比例。进行逻辑回归分析以研究Chiari II型减压、功能病变水平、减压时年龄及气管造口术史之间的关系。
结果
从26个机构识别出的4448例脊髓脊膜膨出患者中，407例（9.15%）至少接受过1次Chiari II型减压。51例患者接受过气管造口术。逻辑回归显示Chiari II型减压与脊髓脊膜膨出的功能病变水平之间存在统计学显著关系，病变水平越靠上，后颅窝减压的可能性越高。同样，2005年前出生的儿童及有气管造口术史的儿童接受Chiari II型减压的可能性显著更高。功能病变水平与气管造口术需求之间无关联。然而在接受Chiari II型减压的儿童中，减压时年龄越小，同时接受气管造口术的可能性显著增加。
结论
NSBPR中脊髓脊膜膨出患者的Chiari II型减压率与先前发表的文献一致。Chiari II型减压与脊髓脊膜膨出的功能病变水平之间存在显著关系，这在之前未曾报道过。接受Chiari II型减压的年幼儿童更有可能接受过气管造口术。似乎存在远离Chiari II型减压的趋势，因为2005年前出生的儿童比2005年及以后出生的儿童更有可能接受Chiari II型减压。
