1Department of Neurosurgery, University of Alabama at Birmingham.
2University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama.
Neurosurg Focus. 2023 Mar;54(3):E8. doi: 10.3171/2022.12.FOCUS22631.
The optimal surgical management of Chiari malformation type I (CM-I) remains controversial and heterogeneous. The authors sought to investigate patient-specific, technical, and perioperative features that may affect the incidence of CSF-related complications including pseudomeningocele and CSF leak at their institution.
The authors performed a single-center, retrospective review of all adult patients with CM-I who underwent posterior fossa decompression. Patient demographics, operative details, and perioperative factors were collected via electronic medical record review. The authors performed Fisher's exact test and independent Student t-tests for categorical and continuous variables, respectively. Univariate regression analysis was performed to determine odds ratios. A multivariable regression analysis was performed for those factors with p < 0.10 or large effect sizes (OR ≥ 2.0 or ≤ 0.50) by univariate analysis. The STROBE guidelines for observational studies were followed.
A total of 59 adult patients were included. Most patients were female (78.0%), and the mean body mass index was 32.2 (± 9.0). Almost one-third (30.5%) of patients had a syrinx on preoperative imaging. All patients underwent expansile duraplasty, of which 47 (79.7%) were from autologous pericranium. Arachnoid opening for fourth ventricular inspection was performed in 26 (44.1%) cases. CSF-related complications were identified in 18 (30.5%) of cases. Thirteen (22.0%) patients required readmission and 11 (18.6%) required intervention such as wound revision (n = 5), wound revision with CSF diversion (n = 4), CSF diversion alone (n = 1), or blood patch (n = 1). Three (5.1%) patients required permanent CSF diversion. Male sex (OR 3.495), diabetes mellitus (OR 0.249), tobacco use (OR 2.53), body mass index more than 30 (OR 2.45), preoperative syrinx (OR 1.733), autologous duraplasty (OR 0.331), and postoperative steroids (OR 2.825) were included in the multivariable analysis. No factors achieved significance by univariate or multivariable analysis (all p > 0.05).
The authors report a single-center, retrospective experience of posterior fossa decompression for 59 adults with CM-I. No perioperative or technical features were found to affect the CSF-related complication rate. More standardized practices within centers are necessary to better delineate the true risk factors and potential protective factors against CSF-related complications.
Chiari 畸形 I 型（CM-I）的最佳手术治疗仍存在争议且具有异质性。作者旨在研究可能影响其机构中脑脊液相关并发症发生率的患者特异性、技术和围手术期特征，包括假性脑膜膨出和脑脊液漏。
作者对在其机构中接受后颅窝减压的所有 CM-I 成年患者进行了单中心回顾性研究。通过电子病历回顾收集患者人口统计学、手术细节和围手术期因素。作者分别对分类变量和连续变量进行 Fisher 确切检验和独立 Student t 检验。进行单变量回归分析以确定优势比。对于单变量分析中 p < 0.10 或大效应量（OR ≥ 2.0 或 ≤ 0.50）的因素进行多变量回归分析。遵循观察性研究的 STROBE 指南。
共纳入 59 例成年患者。大多数患者为女性（78.0%），平均体重指数为 32.2（±9.0）。术前影像学检查发现约三分之一（30.5%）的患者存在脊髓空洞。所有患者均行扩张性硬脑膜成形术，其中 47 例（79.7%）来自自体颅骨膜。26 例（44.1%）进行了蛛网膜开放以检查第四脑室。18 例（30.5%）患者发生与脑脊液相关的并发症。13 例（22.0%）患者需要再次入院，11 例（18.6%）需要干预，包括伤口修复（n=5）、伤口修复伴脑脊液分流（n=4）、单纯脑脊液分流（n=1）或血补丁（n=1）。3 例（5.1%）患者需要永久性脑脊液分流。男性（OR 3.495）、糖尿病（OR 0.249）、吸烟（OR 2.53）、体重指数超过 30（OR 2.45）、术前脊髓空洞（OR 1.733）、自体硬脑膜成形术（OR 0.331）和术后类固醇（OR 2.825）纳入多变量分析。单变量或多变量分析均未发现任何因素具有统计学意义（均 p > 0.05）。
作者报告了在其机构中对 59 例 CM-I 成年患者进行后颅窝减压的单中心回顾性经验。未发现围手术期或技术特征可影响与脑脊液相关的并发症发生率。中心内需要更标准化的操作，以更好地确定与脑脊液相关并发症相关的真正危险因素和潜在保护因素。
