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探索接受不同手术方法的I型Chiari畸形合并脊髓空洞症患者的预后差异。

Exploring the prognostic differences in patients of Chiari malformation type I with syringomyelia undergoing different surgical methods.

作者信息

Zhang Mingchu, Hu Yan, Song Dengpan, Duan Chengcheng, Wei Mingkun, Zhang Longxiao, Lei Shixiong, Guo Fuyou

机构信息

Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.

International Joint Laboratory of Chiari Malformation, Zhengzhou, Henan, China.

出版信息

Front Neurol. 2023 Jan 4;13:1062239. doi: 10.3389/fneur.2022.1062239. eCollection 2022.

Abstract

BACKGROUND

The best surgical treatment of Chiari malformation patients with syringomyelia remains controversial, and whether cerebellar tonsillectomy should be performed has not been decided.

OBJECTIVE

To evaluate the efficacy of posterior fossa decompression with duraplasty (PFDD) and Posterior fossa decompression with resection of tonsils (PFDRT) in patients of Chiari malformation type I (CM-I) with syringomyelia and explore relevant factors affecting prognosis.

PATIENTS AND METHODS

We retrospectively analyzed 182 adult patients of CM-I with syringomyelia who underwent PFDD or PFDRT over a 6-year period, and analyzed their clinical manifestations, imaging features, and follow-up data. Clinical outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS), and imaging outcomes were assessed using the syrinx remission rate. Difference comparisons were performed to compare the differences between different surgical groups. Influencing factors associated with outcome were investigated using bivariate analysis and multiple linear regression analysis.

RESULTS

There were statistically significant differences in CCOS score ( = 0.034) and syrinx remission rates ( = 0.046) between the PFDRT group and the PFDD group after surgery. Regression analysis showed that preoperative motor dysfunction, cerebellar-related symptoms and different surgical methods may have influenced the CCOS score and that brainstem-related symptoms and age may have influenced the syrinx remission rates in the total patient group ( < 0.05). Regression analysis showed that the duration of symptoms, cerebellar-related symptoms and preoperative syrinx diameter may have influenced the CCOS score and that the preoperative cerebellar tonsillar hernia distance may have influenced the postoperative syrinx remission rate in the PFDRT group ( < 0.05). Age and length of hospital stay may have influenced the CCOS score, and brainstem-related symptoms and age may have influenced the syrinx remission rates in the PFDD group ( < 0.05).

CONCLUSION

This study showed that the CCOS score in the PFDRT group was better than that in the PFDD group. Preoperative motor dysfunction, cerebellar-related symptoms, and different surgical methods in patients of CM-I with syringomyelia affected postoperative CCOS score. Both the duration of symptoms and the age of the patients should be actively considered as factors influencing prognosis. Symptomatic CM-I patients with syringomyelia should undergo surgical treatment as early as possible.

摘要

背景

Chiari 畸形合并脊髓空洞症患者的最佳手术治疗方案仍存在争议,小脑扁桃体切除术是否应实施尚未确定。

目的

评估后颅窝减压硬脑膜成形术(PFDD)和后颅窝减压扁桃体切除术(PFDRT)治疗Ⅰ型 Chiari 畸形(CM-I)合并脊髓空洞症患者的疗效,并探讨影响预后的相关因素。

患者与方法

回顾性分析182例在6年期间接受PFDD或PFDRT治疗的成年CM-I合并脊髓空洞症患者,分析其临床表现、影像学特征及随访数据。使用芝加哥 Chiari 疗效量表(CCOS)评估临床疗效,使用空洞缓解率评估影像学疗效。进行差异比较以比较不同手术组之间的差异。采用双变量分析和多元线性回归分析研究与预后相关的影响因素。

结果

术后PFDRT组与PFDD组在CCOS评分(P = 0.034)和空洞缓解率(P = 0.046)方面存在统计学显著差异。回归分析表明,术前运动功能障碍、小脑相关症状及不同手术方式可能影响CCOS评分,而脑干相关症状和年龄可能影响总体患者组的空洞缓解率(P < 0.05)。回归分析显示,症状持续时间、小脑相关症状及术前空洞直径可能影响CCOS评分,而术前小脑扁桃体疝距离可能影响PFDRT组术后空洞缓解率(P < 0.05)。年龄和住院时间可能影响CCOS评分,脑干相关症状和年龄可能影响PFDD组的空洞缓解率(P < 0.05)。

结论

本研究表明PFDRT组的CCOS评分优于PFDD组。CM-I合并脊髓空洞症患者术前运动功能障碍、小脑相关症状及不同手术方式影响术后CCOS评分。症状持续时间和患者年龄均应积极视为影响预后的因素。有症状的CM-I合并脊髓空洞症患者应尽早接受手术治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3f3d/9846178/a29fb31648f3/fneur-13-1062239-g0001.jpg

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