Enslin J M N, Fieggen A G, Figaji A
Red Cross Children's Hospital, Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Childs Nerv Syst. 2019 Oct;35(10):1881-1884. doi: 10.1007/s00381-019-04281-2. Epub 2019 Jul 3.
In this paper, we aimed to review our institutional opinions and experience with Chiari 1 malformation management to determine physician practice and outcomes.
Discussion between 3 clinicians about practice preferences and the management of Chiari 1 worldwide. Retrospective review of clinical cases over a 10-year period (2009-2018).
Although there are some minor differences between clinicians in our practice, our approach is broadly similar. We treat incidental Chiari 1 malformations conservatively, with clinical and radiological surveillance, reserving intervention for patients who develop clinical signs or radiological deterioration. We prefer surgical intervention for patients with typical symptoms or a Chiari 1 malformation with radiological progression. If symptoms are atypical, we prefer surveillance. Our preferred operation is a conservative suboccipital craniectomy with expansion duraplasty and adhesiolysis. Our operative complication rate was low and there was no mortality or major morbidity in our series. Surveillance for incidentally discovered Chiari 1 malformations has been a safe practice in our experience.
Clinical practice among three clinicians in our institution is broadly consistent. We have a conservative approach to Chiari 1 malformation management and our approach appears to have a low morbidity.
在本文中，我们旨在回顾我们机构对Chiari 1畸形管理的观点和经验，以确定医生的实践方法和治疗结果。
3名临床医生就全球范围内Chiari 1畸形的实践偏好和管理方法进行讨论。对10年期间（2009 - 2018年）的临床病例进行回顾性分析。
尽管我们实践中临床医生之间存在一些细微差异，但我们的方法大致相似。对于偶然发现的Chiari 1畸形，我们采取保守治疗，进行临床和影像学监测，仅对出现临床症状或影像学恶化的患者进行干预。对于有典型症状或Chiari 1畸形伴有影像学进展的患者，我们倾向于手术干预。如果症状不典型，我们倾向于进行监测。我们首选的手术是保守的枕下颅骨切除术，同时进行硬脑膜扩大修补和粘连松解。我们的手术并发症发生率较低，在我们的系列病例中没有死亡或严重并发症。根据我们的经验，对偶然发现的Chiari 1畸形进行监测是一种安全的做法。
我们机构的三名临床医生的临床实践大致一致。我们对Chiari 1畸形的管理采取保守方法，且我们的方法似乎发病率较低。
