Wang Xin, Gao Jun, Han Shiyuan, Li Zhimin, Li Yongning
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Neurol Surg B Skull Base. 2020 Feb;81(1):68-74. doi: 10.1055/s-0039-1681040. Epub 2019 Feb 21.
The objective of this study was to investigate whether different angles between the clivus and supraocciput (C-SO angle) in patients with Chiari's malformation type I (CMI) after posterior fossa decompression lead to different clinical and radiographic outcomes. A total of 73 patients who underwent surgical decompression at our institution between 2010 and 2016 were retrospectively divided into two groups: group A, with an angle less than 96 degrees, and group B, with an angle ≥ 96 degrees. Patient clinical outcomes were determined using the Chicago Chiari Outcome Scale (CCOS), and radiographic outcomes were determined by changes in the syrinx size before and after surgery. Direct comparisons were made between the two groups. There were no statistically significant differences between the two groups regarding demographics, preoperative symptoms or radiographic characteristics ( > 0.05), except for the cerebellar tonsillar descent ( ≤ 0.001). The mean overall CCOS score was 13.11 ± 1.99. The total CCOS score was significantly different between the two patient groups ( < 0.05). Moreover, group A demonstrated significantly better postoperative improvements than group B in clinical outcome measures based on the CCOS system ( = 0.035). For radiographic outcomes, the change in the syrinx between the two groups was also significantly different, with a value 0.024. A direct comparison between the two groups revealed that a smaller C-OS angle (< 96 degrees) was related to unsatisfactory clinical and radiographic outcomes. Thus, the C-OS angle may emerge as a predictor of clinical or radiographic outcomes following surgical decompression in patients with CMI.
本研究的目的是调查Ⅰ型Chiari畸形（CMI）患者在进行后颅窝减压术后，斜坡与枕骨大孔上缘之间的不同角度（C-SO角）是否会导致不同的临床和影像学结果。2010年至2016年期间在我院接受手术减压的73例患者被回顾性分为两组：A组，角度小于96度；B组，角度≥96度。使用芝加哥Chiari疗效量表（CCOS）确定患者的临床结果，并通过手术前后空洞大小的变化确定影像学结果。对两组进行直接比较。两组在人口统计学、术前症状或影像学特征方面（ > 0.05）无统计学显著差异，但小脑扁桃体下疝情况除外（ ≤ 0.001）。CCOS总均分是13.11±1.99。两组患者的CCOS总分有显著差异（ < 0.05）。此外，基于CCOS系统的临床结局指标显示，A组术后改善明显优于B组（ = 0.035）。对于影像学结果，两组间空洞的变化也有显著差异，值为 0.024。两组直接比较显示，较小的C-OS角（<96度）与不满意的临床和影像学结果相关。因此，C-OS角可能成为CMI患者手术减压后临床或影像学结果的预测指标。
