Department of Neurosurgery, Division of Spine, China, International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China.
Eur Spine J. 2021 Jun;30(6):1623-1634. doi: 10.1007/s00586-021-06746-y. Epub 2021 Feb 5.
The existing classification in Chiari I malformation (CM-I) has limited significance for the selection of surgical methods.
The purpose of this study was to investigate the surgery of CM-I with syringomyelia based on the high-resolution MR imaging (HRMRI) findings.
Data from 115 patients were collected and retrospectively analyzed. For those with syringomyelia up to the level of C1, HRMRI was performed and according to the communication status between the fourth ventricle and the syringomyelia, patients can be divided into four types, namely Type A: classic communicating; Type B: partial communicating; Type C: non-communicating; Type D: atrophic. All operations were performed with Foramen magnum and Magendie dredging (FMMD), and all intradural factors that may have induced the obstruction of CSF circulation were recorded. The efficiency of operation on syringomyelia was evaluated by mJOA, imaging findings, and complications in the follow-up periods.
The postoperative follow-up period was from 12 to 24 months, with an average of 14.3 months. At 1 year, the mJOA of 115 patients was significantly higher than that before the operations (before surgery 12.1 ± 2.3 vs. after surgery 14. 2 ± 1.4, P < 0.05). In addition, postoperative re-examination showed that the size of the syringomyelia was reduced or completely resolved in patients of Type A, 100% (2/2); Type B, 81% (9/11); Type C, 84% (81/97); and Type D, 20% (1/5).
According to our new classification based on HRMRI, FMMD is the key to surgical treatment, especially for Type A and Type B patients.
Chiari I 畸形（CM-I）的现有分类对手术方法的选择意义有限。
本研究旨在通过高分辨率磁共振成像（HRMRI）研究结果探讨伴有脊髓空洞症的 CM-I 的手术治疗方法。
收集并回顾性分析了 115 例患者的数据。对于空洞延伸至 C1 水平的患者，进行 HRMRI 检查，并根据第四脑室与脊髓空洞之间的沟通情况将患者分为四型，即 A 型：经典交通型；B 型：部分交通型；C 型：非交通型；D 型：萎缩型。所有手术均采用枕骨大孔和 Magendie 疏通术（FMMD），并记录所有可能导致脑脊液循环受阻的硬脊膜内因素。通过 mJOA、影像学发现和随访期间的并发症评估手术治疗脊髓空洞症的效果。
术后随访时间为 12~24 个月，平均 14.3 个月。115 例患者术后 1 年 mJOA 明显高于术前（术前 12.1±2.3 分，术后 14.2±1.4 分，P<0.05）。此外，术后复查发现 A 型患者的脊髓空洞缩小或完全消失，比例为 100%（2/2）；B 型患者为 81%（9/11）；C 型患者为 84%（81/97）；D 型患者为 20%（1/5）。
根据我们基于 HRMRI 的新分类，FMMD 是手术治疗的关键，特别是对于 A 型和 B 型患者。
