Rangari Kamlesh, Das Kuntal Kanti, Singh Suyash, Kumar Krishna G, Bhaisora Kamlesh Singh, Sardhara Jayesh, Mehrotra Anant, Srivastava Arun Kumar, Jaiswal Awadhesh Kumar, Behari Sanjay
Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
Department of Neurosurgery, All India Institute of Medical Sciences, Raebareli, UP, India.
Neurospine. 2021 Mar;18(1):126-138. doi: 10.14245/ns.2040438.219. Epub 2021 Mar 31.
Posterior fossa decompression is the treatment of choice in type 1 Chiari malformation (CM-1) without bony instability. Although surgical fixation has been recommended by a few authors recently, comparative studies to evaluate these treatment strategies using objective outcome tools are lacking.
Seventy-three patients with pure CM-1 (posterior fossa bony decompression [PFBD], n = 21; posterior fossa bony and dural decompression [PFBDD], n = 40; and posterior fixation [PF], n = 12) underwent a postoperative outcome assessment using Chicago Chiari Outcome Score (CCOS). Logistic regression analysis detected predictors of an unfavorable outcome.
Minimally symptomatic patients generally underwent a PFBD while most of the clinically severe patients underwent a PFBDD (p = 0.049). The mean CCOS score at discharge was highest in the PF (12.0 ± 1.41) and lowest in PFBDD group (10.98 ± 1.73, p = 0.087). Patients with minimal preoperative clinical disease severity (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.29-16.31) and PFBDD (AOR, 7.56; 95% CI, 1.70-33.68) represented risks for an unfavorable short-term postoperative outcome. Though long-term outcomes (CCOS) did not differ among the 3 groups (p = 0.615), PFBD group showed the best long-term improvements (mean follow-up CCOS, 13.71 ± 0.95), PFBDD group improved to a comparable degree despite a poorer short-term outcome while PF had the lowest scores. Late deteriorations (n = 3, 4.1%) occurred in the PFBDD group.
Minimally symptomatic patients and PFBDD predict a poor short-term postoperative outcome. PFBD appears to be a durable procedure while PFBDD group is marred by complications and late deteriorations. PF does not provide any better results than posterior fossa decompression alone in the long run.
后颅窝减压术是治疗无骨质不稳定的1型Chiari畸形（CM-1）的首选方法。尽管最近有少数作者推荐手术固定，但缺乏使用客观结果工具来评估这些治疗策略的比较研究。
73例单纯CM-1患者（后颅窝骨性减压[PFBD]，n = 21；后颅窝骨性和硬脑膜减压[PFBDD]，n = 40；后固定[PF]，n = 12）采用芝加哥Chiari结果评分（CCOS）进行术后结果评估。逻辑回归分析确定了不良结果的预测因素。
症状轻微的患者一般接受PFBD，而大多数临床症状严重的患者接受PFBDD（p = 0.049）。出院时平均CCOS评分在PF组最高（12.0±1.41），在PFBDD组最低（10.98±1.73，p = 0.087）。术前临床疾病严重程度最低的患者（调整优势比[AOR]，4.58；95%置信区间[CI]，1.29 - 16.31）和PFBDD患者（AOR，7.56；95%CI，1.70 - 33.68）代表术后短期不良结果的风险。尽管3组的长期结果（CCOS）无差异（p = 0.615），但PFBD组显示出最佳的长期改善（平均随访CCOS，13.71±0.95），PFBDD组尽管短期结果较差，但改善程度相当，而PF组得分最低。PFBDD组发生晚期恶化（n = 3，4.1%）。
症状轻微的患者和PFBDD预示术后短期结果较差。PFBD似乎是一种持久的手术方法，而PFBDD组则受到并发症和晚期恶化的影响。从长远来看，PF并不比单纯后颅窝减压术提供更好的结果。
