Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
World Neurosurg. 2023 Feb;170:e784-e790. doi: 10.1016/j.wneu.2022.11.119. Epub 2022 Nov 29.
Foramen magnum decompression is a common operation used to treat Chiari malformation. There are different surgical techniques; however, some are anecdotally more effective than others. Our aim was to determine whether there is a superior technique in relation to revision rates, presence of persistent postoperative headache and nausea, and syrinx reduction.
This was a retrospective analysis of foramen magnum decompressions performed between 2012 and 2017 for Chiari 1 in a single institution. Three types of operations were performed: 1) bony decompression alone; 2) bony decompression with durotomy and dura left open; 3) bony decompression with opening of dura and duraplasty. We compared postoperative symptoms and revision rates between these 3 operations.
In 168 patients, 185 foramen magnum decompressions were performed. Among the 168 primary operations, in 66 the dura was not opened, in 86 the dura was opened without a duraplasty, and in 16 a duraplasty was performed. Of 185 operations, 17 were revision surgery. For primary procedures, the revision rates were 12 (18%) where the dura was not opened, 4 (5%) where the dura was left open, and 1 (6%) when duraplasty was performed. Severe postoperative headache and nausea occurred in 2 (3%) patients where the dura was not opened, 4 (25%) patients after primary duraplasty, and 64 (74%) patients after primary durotomy.
In this study, rate of revision surgery was highest in patients who had bony decompression without dural opening. Rate of postoperative headache and nausea was highest in the durotomy group. Overall duraplasty had the best results.
枕骨大孔减压术是治疗 Chiari 畸形的常用手术。有不同的手术技术；然而，有些技术据报道比其他技术更有效。我们的目的是确定在翻修率、持续性术后头痛和恶心以及脊髓空洞缩小方面是否存在一种更优越的技术。
这是对 2012 年至 2017 年间在一家机构中为 Chiari 1 型进行的枕骨大孔减压术的回顾性分析。进行了三种类型的手术：1）单纯骨减压；2）骨减压加硬脑膜切开和硬脑膜敞开；3）骨减压加硬脑膜切开和硬脑膜成形术。我们比较了这三种手术术后症状和翻修率。
在 168 例患者中，进行了 185 次枕骨大孔减压术。在 168 例初次手术中，66 例未打开硬脑膜，86 例未行硬脑膜成形术，16 例行硬脑膜成形术。185 例手术中，17 例为翻修手术。对于初次手术，未打开硬脑膜的翻修率为 12（18%），硬脑膜敞开未行硬脑膜成形术的翻修率为 4（5%），行硬脑膜成形术的翻修率为 1（6%）。未打开硬脑膜的患者中有 2 例（3%）出现严重术后头痛和恶心，初次硬脑膜成形术的患者中有 4 例（25%），初次硬脑膜切开的患者中有 64 例（74%）。
在这项研究中，未打开硬脑膜的患者行骨减压术的翻修手术率最高。硬脑膜切开组的术后头痛和恶心发生率最高。总的来说，硬脑膜成形术的效果最好。
