Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
World Neurosurg. 2020 Jun;138:e95-e105. doi: 10.1016/j.wneu.2020.02.015. Epub 2020 Feb 12.
Foramen magnum decompression (FMD) remains the first-line treatment for Chiari malformation type I associated with syringomyelia, although consistent approaches are not used. However, there are few reports on a persistent or recurrent syrinx or worsening neurologic symptoms after FMD.
We retrospectively reviewed medical records of patients who attended Xuanwu Hospital between January 2018 and July 2019 with persistent or recurrent syringomyelia after FMD.
All 8 patients had syringomyelia preoperatively with a mean disease course of 43 (range, 3-120) months and underwent FMD. The presenting symptoms improved in 1 patient. There was radiologic evidence of decreased syrinx size in 1 patient. Worsening syringomyelia presented at a median of 65 (range, 7-168) months after the primary FMD. Secondary decompression was performed in all patients. A structural, pathological cause for the first FMD failure was identified in all cases at the time of the second decompression. Symptoms were resolved in all patients after repeat decompression surgery. Radiologically, 6 patients had a decrease in syringomyelia size. The level of the upper segment of the syringomyelia was higher in 7 of our revision patients, among which 6 patients had a decrease in syringomyelia size. The median follow-up duration after the secondary decompression was 11.5 (range, 6-22) months.
Adults with persistent syringomyelia after FMD and the higher level of the upper segment of the syringomyelia often have a surgically remediable structural cause. The beneficial effect of a secondary decompression should be considered and guide the decision-making of patients with Chiari malformation type I-related syringomyelia.
尽管没有一致的方法，但枕骨大孔减压术（FMD）仍然是 Chiari 畸形 I 型伴脊髓空洞症的一线治疗方法。然而，对于 FMD 后持续性或复发性脊髓空洞症或神经症状恶化的报道很少。
我们回顾性分析了 2018 年 1 月至 2019 年 7 月在宣武医院就诊的 FMD 后持续性或复发性脊髓空洞症患者的病历。
所有 8 例患者术前均有脊髓空洞症，平均病程为 43（范围，3-120）个月，并接受了 FMD 治疗。1 例患者的症状改善。1 例患者的影像学检查显示脊髓空洞缩小。初次 FMD 后中位时间为 65（范围，7-168）个月出现进展性脊髓空洞症。所有患者均进行了二次减压。在二次减压时，所有患者均发现第一次 FMD 失败的结构性、病理性原因。重复减压手术后所有患者的症状均得到缓解。影像学上，6 例患者的脊髓空洞症缩小。7 例再次减压的患者中，6 例患者的脊髓空洞症上节段水平更高，其中 6 例患者的脊髓空洞症缩小。二次减压后中位随访时间为 11.5（范围，6-22）个月。
成人 FMD 后持续性脊髓空洞症且脊髓空洞症上节段水平较高的患者常存在可手术纠正的结构性病因。应考虑二次减压的有益效果，并指导 Chiari 畸形 I 型相关脊髓空洞症患者的决策。
