Mishinov Sergey, Samokhin Alexander, Panchenko Andrey, Stupak Vyacheslav
Department of Neurosurgery, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Ya.L. Tsivyan, Russian Federation.
Department of Experimental, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Ya.L. Tsivyan, Russian Federation.
Surg Neurol Int. 2021 Feb 23;12:72. doi: 10.25259/SNI_960_2020. eCollection 2021.
Concepts of Chiari malformation Type 1 (CM1) surgery in the present time significantly different. The most common complications are pseudomeningocele (12%) and postoperative CSF leak (5%). The development of pseudomeningocele may be associated with inappropriate restoration of bone and muscles relations.
The pilot study involved 11 patients aged 24-64 years with a diagnosis of CM1 who had indications for surgical treatment. Special titanium implant enabling fixation of the occipital and cervical muscles at the projections of their normal attachments was developed, it was placed to occipital bone on the final stages of surgical intervention. Surgical technique promoted tightened wound closure neutralizing formation of "dead space" at the place of occipital craniectomy and between muscle layers. The implant was produced by direct metal laser sintering method for each patient individually.
There were no complications during the hospitalization and follow-up period. Postoperative MRI demonstrated adequate formation of the cisterna magna and the absence of pseudomeningocele. During follow-up period there were no signs of pseudomeningocele, CSF leak, surgical scar complications, implant-associated infections, and other complications.
In the study group, no pseudomeningocele cases as long as any other complications associated with surgery had been revealed. The efficacy of the proposed surgical technique using the developed implant should be evaluated in clinical trials with larger patient samples. To simplify preoperative planning and manufacturing of the implant for each patient individually, a set of implants with different specified sizes was developed.
目前关于 Chiari 畸形 1 型（CM1）手术的概念差异很大。最常见的并发症是假性脑脊膜膨出（12%）和术后脑脊液漏（5%）。假性脑脊膜膨出的发生可能与骨和肌肉关系恢复不当有关。
该初步研究纳入了 11 例年龄在 24 - 64 岁之间、诊断为 CM1 且有手术治疗指征的患者。研发了一种特殊的钛植入物，可在枕部和颈部肌肉正常附着点的投影处固定这些肌肉，并在手术干预的最后阶段将其放置于枕骨上。手术技术促进了伤口的紧密闭合，消除了枕骨颅骨切除术部位和肌肉层之间“死腔”的形成。该植入物通过直接金属激光烧结法为每位患者单独制作。
住院期间及随访期均无并发症发生。术后 MRI 显示大池形成良好且无假性脑脊膜膨出。随访期间未出现假性脑脊膜膨出、脑脊液漏、手术切口并发症、植入物相关感染及其他并发症的迹象。
在研究组中，未发现假性脑脊膜膨出病例以及任何与手术相关的其他并发症。所提出的使用研发的植入物的手术技术的疗效应在更大样本量的临床试验中进行评估。为了简化术前规划并为每位患者单独制作植入物，研发了一组具有不同特定尺寸的植入物。
