Günerhan Göksal, Çağıl Emin, Dağlar Zeynep, Gündüz Uğur Kemal, Dalgıç Ali, Belen Ahmet Deniz
Department of Neurosurgery, University of Healthy Science, Ankara Bilkent City Hospital, Ankara, Türkiye.
J Neurol Surg B Skull Base. 2023 Aug 11;85(2):202-211. doi: 10.1055/a-2127-0094. eCollection 2024 Apr.
The aim this study is to present the results of the minimal invasive neuroendoscopic-assisted system application as an alternative to traditional surgery in patients with Chiari malformation type 1 (CM type 1) with/without syringomyelia. In the study, data of 22 symptomatic patients were prospectively collected. Before and after the operation, patient characteristics, computed tomography, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow dynamics MRI, and outcome scales scores were recorded. Foramen magnum decompression and C1 total laminectomy were performed. The fibrous band at the craniocervical junction was opened and a durotomy was performed. In patients with a syrinx, the pre- and postoperative axial and sagittal lengths of the syrinx were measured and compared. The mean age of the patients was 32 ± 5 years. There were eight male patients. Ten patients had syrinx. The mean visual analog scale (VAS) score before and after surgery was 8 ± 1.06 and 2.18 ± 1.13, respectively. When evaluated according to the Chicago Chiari Outcome Scale, there was improvement in 20 patients, while there was no change in 2 patients. Syrinx resolved completely in 3 of 10 (13.6%) patients with syringomyelia, and the syrinx volume decreased in 3 patients (13.6%). In 4 of 10 (18.1%) patients, there was no significant change in the syrinx volume. The average operation time was 105 minutes (80-150 minutes). The average blood loss was 40 mL (20-110 mL). Although the study was limited due to the small number of patients with a short follow-up, endoscopic decompression was a safe and effective technique for surgery in CM type 1 patients.
本研究的目的是呈现微创神经内镜辅助系统应用于1型Chiari畸形（CM1型）伴或不伴脊髓空洞症患者的结果，以替代传统手术。在本研究中，前瞻性收集了22例有症状患者的数据。记录手术前后的患者特征、计算机断层扫描、磁共振成像（MRI）、脑脊液（CSF）流动动力学MRI及结果量表评分。进行了枕骨大孔减压和C1全椎板切除术。打开颅颈交界处的纤维带并进行硬脑膜切开术。对于有脊髓空洞的患者，测量并比较脊髓空洞术前和术后的轴向及矢状径长度。患者的平均年龄为32±5岁。有8例男性患者。10例患者有脊髓空洞。手术前后平均视觉模拟量表（VAS）评分分别为8±1.06和2.18±1.13。根据芝加哥Chiari结果量表评估，20例患者有改善，2例患者无变化。10例脊髓空洞症患者中有3例（13.6%）脊髓空洞完全消失，3例患者（13.6%）脊髓空洞体积减小。10例患者中有4例（18.1%）脊髓空洞体积无显著变化。平均手术时间为105分钟（80 - 150分钟）。平均失血量为40毫升（20 - 110毫升）。尽管由于患者数量少且随访时间短，本研究存在局限性，但内镜减压对于CM1型患者的手术是一种安全有效的技术。
