Jia Chong, Li Hongwei, Wu Junru, Gao Kun, Zhao Cheng Bin, Li Mu, Sun Xiang, Yang Bo
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, China.
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, China.
Clin Neurol Neurosurg. 2019 Jan;176:1-7. doi: 10.1016/j.clineuro.2018.11.008. Epub 2018 Nov 10.
The current study aimed to assess the two surgical procedures of posterior fossa decompression (PDF) in treating Chiari malformation type I (CM-1) complicated by syringomyelia (SM), and to evaluate the postoperative complications, surgical effects and prognosis.
A retrospective study was performed on 115 adult CM-I patients undergoing surgical treatment from November 2013 to November 2016 in a single comprehensive hospital. These patients underwent the surgical procedure of either posterior fossa decompression with duraplasty (PFDD) or posterior fossa decompression combined with the resection of tonsils (PFDRT) by five experienced neurosurgeon in a single center. The clinical outcomes of these two surgical procedures were evaluated through comparing the clinical data before and 6 months after the operation.
A total of 115 patients, including 35 men and 80 women with the mean age of 43.4 ± 10.1 years (range, 16-60 years), were enrolled in the current study. 37 out of the 115 patients underwent PFDD, while the remaining 78 received PFDRT according to the surgical assessment. The operation time in PFDRT group (159.3 ± 40.0 min) was higher than that in PFDD group (134.1 ± 30.8 min) (P < 0.05). Besides, 20 cases in PFDRT group (20/78) developed postoperative dizziness and headache, and such incidence was higher than that in PFDD group (3/37) (P < 0.05). After 6 months of follow-up, a total of 69 patients (88.4%) in PFDRT group had alleviated symptoms, while 31 (83.8%) patients in PFDD group had improved symptoms. Altogether, the SM cavity was reduced in 54 patients (69.2%) in PFDRT group and 29 (78.4%) in PFDD group, respectively, after the operation. No statistical differences in symptom improvement and cavity reduction rate could be witnessed between the two groups.
Our study suggests that both PFDRT and PFDD can achieve comparable short-term clinical outcomes for adult CM-I patients. Surgical treatment is considered to be a reliable choice for the treatment of adult CM-I patients. Typically, PFDRT may lead to a higher risk of aseptic inflammatory complication. The precise surgical procedure should be selected based on detailed conditions of patients.
本研究旨在评估后颅窝减压术（PDF）治疗Ⅰ型Chiari畸形（CM-1）合并脊髓空洞症（SM）的两种手术方法，并评估术后并发症、手术效果及预后。
对2013年11月至2016年11月在一家综合性医院接受手术治疗的115例成年CM-Ⅰ患者进行回顾性研究。这些患者在单一中心由五位经验丰富的神经外科医生进行了后颅窝减压联合硬脑膜成形术（PFDD）或后颅窝减压联合扁桃体切除术（PFDRT）。通过比较手术前后6个月的临床数据来评估这两种手术方法的临床疗效。
本研究共纳入115例患者，其中男性35例，女性80例，平均年龄43.4±10.1岁（范围16 - 60岁）。115例患者中37例行PFDD，其余78例根据手术评估接受PFDRT。PFDRT组的手术时间（159.3±40.0分钟）高于PFDD组（134.1±30.8分钟）（P<0.05）。此外，PFDRT组有20例（20/78）患者术后出现头晕和头痛，其发生率高于PFDD组（3/37）（P<0.05）。随访6个月后，PFDRT组共有69例（88.4%）患者症状缓解，PFDD组有31例（83.8%）患者症状改善。术后，PFDRT组分别有54例（69.2%）患者、PFDD组有29例（78.4%）患者的脊髓空洞腔缩小。两组在症状改善和空洞缩小率方面无统计学差异。
我们的研究表明，PFDRT和PFDD对成年CM-Ⅰ患者均可取得相当的短期临床疗效。手术治疗被认为是治疗成年CM-Ⅰ患者的可靠选择。通常，PFDRT可能导致无菌性炎症并发症的风险更高。应根据患者的具体情况选择精确的手术方法。
