Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Edgbaston, UK.
Br J Neurosurg. 2022 Dec;36(6):750-755. doi: 10.1080/02688697.2020.1823935. Epub 2020 Sep 23.
Craniovertebral decompression is performed for symptomatic Chiari malformation type 1, with or without syringomyelia. In a few patients the symptoms and/or syrinx persist or recur, in which case revision surgery may be offered. The aim of this study was to examine the cause of failure of primary surgery and to assess the outcomes for revision cranio-vertebral decompression.
We retrospectively reviewed all revision cranio-vertebral decompressions performed in our centre over an eighteen-year period. A total of 35 patients were identified (23 females; 12 males). Twenty patients had isolated Chiari malformation type 1 and a further fifteen had associated syringomyelia. The mean follow up period was 4-years (range:1-12 years).
The mean time to revision was 7 years after the primary surgery. The commonest operative finding was that of dense arachnoid scar tissue, obstructing movement of CSF across the craniovertebral junction. Overall, 32 of the 35 patients reported improvement after surgery, including all 15 patients with syringomyelia. Improvement was maintained in the longer term in more than two thirds of those patients who underwent revision craniovertebral decompression.
Failure of primary craniovertebral decompression for Chiari malformation most often results from the formation dense scar tissue at the operation site, obstructing CSF movement. Revision cranio-vertebral decompression can provide early symptomatic relief in most patients and this benefit is sustained in at least two thirds of cases, in the medium term at least. Patients with concomitant syringomyelia appear to derive most benefit from revision surgery.
颅颈减压术用于治疗有症状的 Chiari 畸形 1 型，伴或不伴脊髓空洞症。少数患者的症状和/或脊髓空洞症持续存在或复发，此时可能需要进行翻修手术。本研究旨在探讨初次手术失败的原因，并评估翻修颅颈减压术的结果。
我们回顾性分析了 18 年来在我们中心进行的所有翻修颅颈减压术。共确定了 35 例患者（23 例女性；12 例男性）。20 例患者为单纯 Chiari 畸形 1 型，另有 15 例患者伴有脊髓空洞症。平均随访时间为 4 年（范围：1-12 年）。
初次手术后翻修的平均时间为 7 年。最常见的手术发现是蛛网膜致密瘢痕组织，阻碍 CSF 在颅颈交界处的流动。总体而言，35 例患者中有 32 例在手术后报告症状改善，包括所有 15 例伴有脊髓空洞症的患者。在接受翻修颅颈减压术的患者中，超过三分之二的患者在长期随访中保持了改善。
Chiari 畸形初次颅颈减压术失败最常因手术部位形成致密瘢痕组织，阻碍 CSF 流动所致。翻修颅颈减压术可使大多数患者早期获得症状缓解，这种益处至少在中期至少三分之二的病例中得以维持。伴有脊髓空洞症的患者似乎从翻修手术中获益最大。
