He Yunsen, Liu Ping, Zhang Mengjun, Guo Lili, Zheng Tao, Yao Yuanpeng, Zheng Qiang, Bao Mingbin, Jiang Chuan, Wu Bo, Liu Jinping
Department of Neurosurgery, Sichuan Provincial People's Hospital Ringgold Standard Institution, University of Electronic Science and Technology of China, Chengdu, Sichuan, People's Republic of China.
Department of Neuropsychology, Sichuan Provincial Center for Mental Health, Sichuan, People's Republic of China.
J Neurol Surg B Skull Base. 2022 Dec 2;84(6):616-628. doi: 10.1055/a-1932-8692. eCollection 2023 Dec.
This study aimed to establish a novel grading system, based on the craniovertebral junction compression severity index (CVJCSI) for multidirectional quantification at the foramen magnum plane for Chiari malformation type I (CMI). The CVJCSI grading system was established to stratify patients based on the ventral (modified clivoaxial angle < 138°), dorsal (tonsil herniation), and central (brainstem herniation) CVJ (craniovertebral junction) compression, the CVJCSI grading system was established to stratify patients. The optimal surgical method for each grade was recommended by intragroup comparisons regarding the efficacy of the three operations. Finally, according to the CVJCSI grading system, a prospective validation trial was performed and surgically treated for internal validation. Based on the retrospective study ( = 310), the CVJCSI included six grades: Among all available variables, only the CVJCSI and surgical methods significantly affected the CCOS. The CCOS scores, overall and for each CVJCSI grade, increased in the prospective cohort ( = 42) compared with that in the retrospective analysis. The CVJCSI can be used to stratify CMI patients. The higher the CVJCSI grade, the more severe the CVJ compression and the worse posterior fossa deformity. Meanwhile, the CVJCSI was negatively correlated with the CCOS. The lower the CVJCSI grade, the better the response to surgery, and the less-invasive surgical procedures were warranted. Finally, the prospective cohort study validated the proposed CVJCSI-based surgical protocols.
本研究旨在基于颅颈交界区压迫严重程度指数（CVJCSI）建立一种新型分级系统，用于对Ⅰ型Chiari畸形（CMI）在枕骨大孔平面进行多方向量化。基于腹侧（改良斜坡轴角＜138°）、背侧（扁桃体疝）和中央（脑干疝）的颅颈交界区（CVJ）压迫情况，建立了CVJCSI分级系统以对患者进行分层。通过对三种手术疗效的组内比较，推荐了各分级的最佳手术方法。最后，根据CVJCSI分级系统进行了前瞻性验证试验，并进行手术治疗以进行内部验证。基于回顾性研究（n = 310），CVJCSI包括六个等级：在所有可用变量中，只有CVJCSI和手术方法对CCOS有显著影响。与回顾性分析相比，前瞻性队列（n = 42）中的CCOS评分在总体及各CVJCSI分级中均有所增加。CVJCSI可用于对CMI患者进行分层。CVJCSI分级越高，CVJ压迫越严重，后颅窝畸形越严重。同时，CVJCSI与CCOS呈负相关。CVJCSI分级越低，手术反应越好，所需的手术侵入性越小。最后，前瞻性队列研究验证了所提出的基于CVJCSI的手术方案。
