Sunshine Kerrin S, Elder Theresa A, Tomei Krystal L
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
J Neurosurg Case Lessons. 2021 Feb 8;1(6):CASE20114. doi: 10.3171/CASE20114.
The complex Chiari malformation has been identified in a subset of Chiari patients at higher risk for worsening symptoms following Chiari decompression. Although parameters such as the clivoaxial angle and the perpendicular distance of the dens to the line from the basion to the inferoposterior part of the C2 body (pBC2) have been evaluated to help with the prediction of risk, the decision to pursue an occipitocervical fusion in lower-risk patients does not come without inherent risk.
The authors present 2 patients who had symptoms of worsening ventral brainstem compression following Chiari decompression, neither of whom was categorized in the highest risk category for occipitocervical instability. In addition, neither patient had gross instability on radiographic imaging. A trial with rigid C-collar immobilization provided relief of symptoms in both patients and allowed reassurance of the likelihood of success of occipitocervical fusion.
In patients without clear radiographic instability following Chiari decompression, a C-collar trial may provide a noninvasive option for assessing the potential success of occipitocervical fusion.
在一部分Chiari患者中发现了复杂的Chiari畸形，这些患者在Chiari减压术后症状恶化的风险较高。尽管已经评估了一些参数，如斜坡轴角和齿状突到从颅底到C2椎体下后部连线的垂直距离（pBC2），以帮助预测风险，但在低风险患者中决定进行枕颈融合并非没有固有风险。
作者介绍了2例在Chiari减压术后出现腹侧脑干压迫症状恶化的患者，这2例患者均未被归类为枕颈不稳定的最高风险类别。此外，两名患者在影像学检查中均未出现明显不稳定。使用硬质C形颈托固定的试验使两名患者的症状均得到缓解，并让人放心枕颈融合成功的可能性。
对于Chiari减压术后无明显影像学不稳定的患者，C形颈托试验可为评估枕颈融合的潜在成功率提供一种非侵入性选择。
