De Marco R, Piatelli G, Portonero I, Fiaschi P, Secci F, Pacetti M, Pavanello M
Department of Neurosurgery, Istituto Giannina Gaslini Children's Hospital, Genova, Italy; Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", "Città della Salute e della Scienza" University Hospital, University of Turin, Turin, Italy.
Department of Neurosurgery, Istituto Giannina Gaslini Children's Hospital, Genova, Italy.
Neurochirurgie. 2023 Mar;69(2):101423. doi: 10.1016/j.neuchi.2023.101423. Epub 2023 Feb 10.
Increasing the posterior fossa volume is the mainstay of treatment for Chiari type 1 Malformation (C1M) and type 1.5 (C1.5M). Different options to restore CSF flow have been described but no consensus has been reached yet. Bony decompression of posterior cranial fossa with dural opening provides good results but at the price of complications such as pseudomeningocele and aseptic meningitis. A single center retrospective analysis was conducted to find any relationships between outcome and perioperative factors. As a second goal a specific analysis was conducted on the complications and their hypothetical causes.
All the pediatric patients who underwent to posterior fossa bony decompression and dural opening for C1M or C1.5M in the period 2008-2020 were included in the study. A minimum period of three-months follow-up was considered among the inclusion criteria.
A population of fifty-three consecutive patients was collected. Pseudomeningocele and a mild meningeal irritation resulted the most frequent complications. Considering preoperative and intraoperative factors, the type of dural graft showed a relatively strong correlation (P<.01) with pseudomeningocele appearance and the development of meningism. In the latter case, a short course of steroids was the only treatment required to control symptoms.
Different factors could influence the outcome in Chiari Malformation surgery and eventually the development of complications. An adequate dural graft selection is of paramount importance when a dural opening for posterior fossa augmentation is planned. In case of mild meningeal irritation, a trial with short course steroids could avoid revision surgery.
增加后颅窝容积是治疗1型Chiari畸形（C1M）和1.5型（C1.5M）的主要方法。已经描述了恢复脑脊液流动的不同方法，但尚未达成共识。后颅窝骨性减压并打开硬脑膜可取得良好效果，但代价是会出现诸如假性脑膜膨出和无菌性脑膜炎等并发症。进行了一项单中心回顾性分析，以寻找结果与围手术期因素之间的任何关系。作为第二个目标，对并发症及其可能的原因进行了具体分析。
本研究纳入了2008年至2020年期间因C1M或C1.5M接受后颅窝骨性减压和硬脑膜打开术的所有儿科患者。纳入标准包括至少三个月的随访期。
共收集了53例连续患者。假性脑膜膨出和轻度脑膜刺激是最常见的并发症。考虑术前和术中因素，硬脑膜移植类型与假性脑膜膨出的出现和脑膜刺激征的发生显示出相对较强的相关性（P<0.01）。在后一种情况下，短期使用类固醇是控制症状所需的唯一治疗方法。
不同因素可能影响Chiari畸形手术的结果，并最终影响并发症的发生。当计划进行后颅窝扩大的硬脑膜打开术时，选择合适的硬脑膜移植至关重要。在轻度脑膜刺激的情况下，短期使用类固醇进行试验可避免翻修手术。
