Department of Neurological Surgery, New York Presbyterian Hospital - Weill Cornell Medical College, New York, New York.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Neurosurgery. 2020 Dec 15;88(1):E60-E66. doi: 10.1093/neuros/nyaa326.
The pathophysiological connection between Chiari malformation and syringomyelia is accepted. Debate remains, however, how can we best define changes in syringomyelia following surgery.
To introduce a grading system focusing on syrinx reduction based on routinely and reproducible radiological information, and provide a suggestion of the application of this scale for prediction of patient's prognoses.
Data from 48 patients with Chiari malformation and syringomyelia were compiled. We calculated syrinx cross-sectional area by approximating an ellipse in the largest axial plane. We compared the percentage of reduction or enlargement following surgery. The percentage change was grouped into four grades: Grade 0 = Increasing size, grade I ≤ 50% reduction, grade II = 50% to 90% reduction, grade III ≥ 90% reduction.
A total of 89.6% of patients had syrinx improvement after surgery. A total of 5 patients were grade 0, 14 were grade I, 20 patients were grade II, and 9 patients met criteria for grade III. The mean postoperative syrinx area was 24.1 mm2 (0-169 mm2) with a mean syrinx reduction of 62.7%.
Radiological improvement of syringomyelia can be mathematically defined and standardized to assist in communication in outcome-based trials. Radiological resolution is expected most patients.
Chiari 畸形和脊髓空洞症之间的病理生理学联系已被接受。然而，如何最好地定义手术后脊髓空洞症的变化仍存在争议。
介绍一种基于常规和可重复的影像学信息，重点关注脊髓空洞缩小的分级系统，并提供该量表在预测患者预后中的应用建议。
收集了 48 例 Chiari 畸形伴脊髓空洞症患者的数据。我们通过在最大轴位平面近似椭圆来计算脊髓空洞的横截面积。我们比较了手术后的空洞缩小或扩大百分比。百分比变化分为四级：0 级=增大，I 级≤50%缩小，II 级=50%至 90%缩小，III 级≥90%缩小。
手术后，89.6%的患者脊髓空洞症得到改善。共有 5 例患者为 0 级，14 例为 I 级，20 例为 II 级，9 例符合 III 级标准。术后平均脊髓空洞面积为 24.1mm²（0-169mm²），平均脊髓空洞缩小 62.7%。
脊髓空洞症的影像学改善可以通过数学方法定义和标准化，以协助基于结果的试验中的沟通。预计大多数患者的影像学结果会得到改善。
