成人寰枕减压并硬脑膜成形术治疗 Chiari 畸形 I 型：297 例系列研究。
Long-term outcomes of foramen magnum decompression with duraplasty for Chiari malformation type I in adults: a series of 297 patients.
机构信息
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; and.
2China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
出版信息
Neurosurg Focus. 2023 Mar;54(3):E5. doi: 10.3171/2022.12.FOCUS22627.
OBJECTIVE
Foramen magnum decompression with duraplasty (FMDD) is one of the most frequently utilized surgical treatments for Chiari malformation type I (CMI) in adults. However, its long-term outcomes remain controversial. The object of this study was to evaluate the long-term outcomes of FMDD in adults with CMI.
METHODS
In total, 297 adults with CMI who had undergone FMDD at the authors' institution between 2011 and 2020 were included in this retrospective study. Long-term (> 1 year) outcomes were evaluated using the Chicago Chiari Outcome Scale (CCOS), visual analog scale (VAS), and Japanese Orthopaedic Association (JOA) scale.
RESULTS
The median patient age was 44 years (range 18-65 years). The mean clinical follow-up period was 67 months (range 14-123 months). Compared with preoperative conditions, the postoperative syringomyelia regression rate was 91.3% (242/265), and the cerebellar tonsil ascended in 18.2% of patients (54/297), was stable in 64.3% (191/297), and continuously descended in 17.5% (52/297). Long-term clinical follow-up data were acquired from 267 patients. According to the CCOS score, the patient's condition improved in 62.5% of cases (167/267), was stable in 31.8% (85/267), and worsened in 5.6% (15/267). According to the VAS score, the patient's condition improved in 59.5% of cases (110/185), remained unchanged in 27.6% (51/185), and worsened in 13.0% (24/185) among the follow-up patients with relevant data. According to the JOA score, the patient's condition improved in 40.1% of cases (107/267), remained unchanged in 50.2% (134/267), and worsened in 9.7% (26/267). Notably, there was no association between clinical outcomes and syringomyelia regression (p = 0.227) or changes in the cerebellar tonsillar position (p = 0.323).
CONCLUSIONS
FMDD is a simple, safe, and effective surgical procedure for adult CMI that yields significant and sustained improvement in clinical and radiological outcomes. However, clinical improvement does not always correlate with syringomyelia regression and cerebellar tonsillar shift.
目的
寰枕减压硬脑膜成形术（FMDD）是成人 Chiari 畸形 I 型（CMI）最常采用的手术治疗方法之一。然而，其长期疗效仍存在争议。本研究旨在评估 FMDD 治疗成人 CMI 的长期疗效。
方法
回顾性分析 2011 年至 2020 年在作者所在机构接受 FMDD 的 297 例 CMI 成人患者的临床资料。采用芝加哥 Chiari 结局量表（CCOS）、视觉模拟评分（VAS）和日本矫形协会（JOA）评分评估长期（>1 年）疗效。
结果
患者中位年龄为 44 岁（18-65 岁）。平均临床随访时间为 67 个月（14-123 个月）。与术前相比，术后脊髓空洞症消退率为 91.3%（242/265），小脑扁桃体上移占 18.2%（54/297），稳定占 64.3%（191/297），持续下移占 17.5%（52/297）。267 例患者获得长期临床随访资料。根据 CCOS 评分，167 例（62.5%）患者病情改善，85 例（31.8%）病情稳定，15 例（5.6%）病情恶化。根据 VAS 评分，110 例（59.5%）患者病情改善，51 例（27.6%）病情无变化，24 例（13.0%）病情恶化。根据 JOA 评分，107 例（40.1%）患者病情改善，134 例（50.2%）病情稳定，26 例（9.7%）病情恶化。值得注意的是，临床疗效与脊髓空洞症消退（p=0.227）或小脑扁桃体位置变化（p=0.323）无显著相关性。
结论
FMDD 是治疗成人 CMI 的一种简单、安全、有效的手术方法，可显著改善临床和影像学结局，并具有持续疗效。然而，临床改善并不总是与脊髓空洞症消退和小脑扁桃体移位相关。
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