Nikoobakht Mehdi, Shojaei Hamidreza, Gerszten Peter C, Shojaei Seyedeh Fahimeh, Mollahoseini Reza, Azar Maziar
Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences , Tehran , Iran.
Department of Neurosurgery, University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania.
Br J Neurosurg. 2019 Oct;33(5):481-485. doi: 10.1080/02688697.2019.1617407. Epub 2019 May 17.
Posterior fossa decompression both with and without duraplasty are accepted treatments for symptomatic adult patients with Chiari Malformations Type 1 (CM-1). There is still debate of the superiority of one technique over the other. The purpose of this study was to determine the clinical and craniometrical imaging outcomes of a series of patients who underwent posterior fossa decompression with duraplasty. All adult patients with symptomatic CM-1 operated at a single institution with a minimum of 6 months follow-up were enrolled prospectively. Clinical outcomes and craniometrical parameters based upon MR imaging pre- and post-surgery were analyzed. A series of 33 consecutive patients who met the inclusion criteria were enrolled; mean age of 33.93 ± 10 years (range 14-56 years). The most common preoperative complaint was headache. The most common clinical sign was sensory dysfunction which was relieved or improved in 63% of patients. The mean syringomyelia size had a significant reduction after the surgery ( = .01). The mean tonsillar descent also had significant reduction ( = .00). The mean McRae line length before the surgery and after that were 33.4 and 53.1 mm respectively that this change was not statistically significant ( = .42). The odontoid process parameters had no significant changes after surgery. Posterior fossa decompression surgery with duraplasty can improve both clinical and imaging outcomes such as syringomyelia size and tonsillar descent for patients with symptomatic CM-1. However, no significant difference was found in craniometrical parameters before and after the surgery.
对于有症状的成年1型Chiari畸形（CM-1）患者，行或不行硬脑膜成形术的后颅窝减压术都是公认的治疗方法。关于这两种技术哪种更具优势仍存在争议。本研究的目的是确定一系列接受硬脑膜成形术后颅窝减压术患者的临床和颅骨测量影像学结果。前瞻性纳入了在单一机构接受手术且随访至少6个月的所有有症状的成年CM-1患者。分析基于术前和术后磁共振成像的临床结果和颅骨测量参数。纳入了连续33例符合纳入标准的患者；平均年龄33.93±10岁（范围14 - 56岁）。最常见的术前主诉是头痛。最常见的临床体征是感觉功能障碍，63%的患者症状得到缓解或改善。术后脊髓空洞症平均大小显著减小（P = 0.01）。扁桃体下移平均也显著减小（P = 0.00）。术前和术后McRae线平均长度分别为33.4和53.1mm，这种变化无统计学意义（P = 0.42）。术后齿状突参数无显著变化。对于有症状的CM-1患者，硬脑膜成形术后颅窝减压术可改善临床和影像学结果，如脊髓空洞症大小和扁桃体下移。然而，手术前后颅骨测量参数未发现显著差异。
