Butensky Samuel, Rodgers Shaun, Baron Shanna, Schneider Steven, Mittler Mark
Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA.
Division of Pediatric Neurosurgery, Cohen Children's Medical Center of New York, New Hyde Park, NY, 11040, USA.
Childs Nerv Syst. 2020 Jul;36(7):1399-1405. doi: 10.1007/s00381-020-04667-7. Epub 2020 May 25.
The goals of this study were to compare clinical outcomes in patients with Chiari Malformation Type I (CMI) receiving posterior fossa decompression with (PFDD) or without duraplasty (PFD).
We conducted a retrospective analysis of 178 consecutive cases of 157 patients undergoing PFDD or PFD for CMI at Cohen Children's Medical Center between 2007 and 2017. Clinical improvement was defined as a clear reduction of preoperative symptoms after surgery as reported by patients and parents. An improvement of syrinx was derived from radiologic comparison of pre- and postoperative MR imaging. Chi-square analysis was performed to analyze the association between duraplasty and clinical parameters (alpha = 0.05).
The primary presenting complaint was headache (142/178; 80%), followed by neck, back, and upper extremity pain, and numbness or tingling (49/178; 28%). Seventy patients (78/178; 44%) underwent PFD, and 100 patients (100/178; 56%) underwent PFDD. Overall, 143 patients (143/178; 80%) experienced subjective improvement with no statistically significant difference between the two surgical techniques (p = 0.705). The number of patients receiving PFDD with syrinx improvement or stabilization (55/59; 93%) was statistically larger than those that received PFD (8/13; 62%) (p = 0.008). PFDD was associated with greater complications than PFD alone. There were 35 cases of reoperation overall (35/178; 19%), and there was no statistically significant difference in reoperation rate between PFD and PFDD (p = 0.255).
There appears to be a role for PFDD in patients with severe syringomyelia, but overall, PFD alone may be safely offered as the initial surgical intervention for symptomatic CMI patients.
本研究的目的是比较接受后颅窝减压术并使用硬脑膜成形术（PFDD）或不使用硬脑膜成形术（PFD）的Ⅰ型Chiari畸形（CMI）患者的临床结局。
我们对2007年至2017年间在科恩儿童医疗中心接受PFDD或PFD治疗CMI的157例患者的178例连续病例进行了回顾性分析。临床改善定义为患者和家长报告术后术前症状明显减轻。空洞的改善来自术前和术后磁共振成像的影像学比较。进行卡方分析以分析硬脑膜成形术与临床参数之间的关联（α = 0.05）。
主要的主诉是头痛（142/178；80%），其次是颈部、背部和上肢疼痛，以及麻木或刺痛（49/178；28%）。70例患者（78/178；44%）接受了PFD，100例患者（100/178；56%）接受了PFDD。总体而言，143例患者（143/178；80%）主观症状得到改善，两种手术技术之间无统计学显著差异（p = 0.705）。空洞改善或稳定的接受PFDD的患者数量（55/59；93%）在统计学上多于接受PFD的患者（8/13；62%）（p = 0.008）。PFDD比单独的PFD并发症更多。总体有35例再次手术病例（35/178；19%），PFD和PFDD之间的再次手术率无统计学显著差异（p = 0.255）。
PFDD在严重脊髓空洞症患者中似乎有作用，但总体而言，单独的PFD可安全地作为有症状CMI患者的初始手术干预。
