Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia.
Childs Nerv Syst. 2024 Dec;40(12):4083-4087. doi: 10.1007/s00381-024-06614-2. Epub 2024 Sep 30.
Pre-operative fourth ventricle roof angle (FVRA) has recently been highlighted as a novel radiographic predictor of clinical severity in Chiari type-I malformation (CM-I) as reported by Seaman et al. (J Neurosurg Pediatr 25:1-8, 2021). This has led to suggestions that FVRA could be included in algorithms to determine indications for surgery. We aimed to test the accuracy of FVRA as a predictor of clinical severity and its effect on post-operative outcome in a large retrospective cohort of paediatric patients who underwent decompression for CM-I.
Patients undergoing craniocervical decompression for CM-I at the Queensland Children's Hospital and Mater Hospital, Brisbane, between 2006 and 2018 were included. Data was collected from 66 patients aged 0-18 years. Post-operative outcome was assessed by calculating Chicago Chiari Outcomes Score (CCOS) at follow-up. The FVRA was taken from a mid-sagittal T1-weighted MRI as previously described (Seaman et al. in J Neurosurg Pediatr 25:1-8, 2021). The angle is subtended between superior and inferior medullary velum.
Whilst results from Seaman et al. demonstrated a strong correlation between a FVRA > 65° and symptomatic CM-I, this did not translate to our dataset (p = 0.61). Additionally, pre-operative FVRA is not useful as a predictive tool for post-surgical outcome as assessed by CCOS (p = 0.50), and post-operative reduction in FVRA did not correlate with improved outcomes (p = 0.81). We did note significantly worse outcomes in patients presenting with pre-operative brainstem dysfunction (p = 0.03).
Paediatric CM-I is a challenging cohort to manage, often due to young age and a lack of language skills. There is a heavy reliance on radiological findings. Whilst FVRA has previously been reported to be of value as a determinant of clinical severity in adult and paediatric patients, we find that this measurement is of dubious value in our retrospective cohort.
最近，Seaman 等人报告称，术前第四脑室顶角度（FVRA）可作为 Chiari 型-I 畸形（CM-I）临床严重程度的新型影像学预测指标。这导致有人建议将 FVRA 纳入确定手术适应证的算法中。我们旨在通过对接受 CM-I 减压手术的大量儿科患者的回顾性队列研究来检验 FVRA 作为临床严重程度预测指标的准确性及其对术后结果的影响。
纳入 2006 年至 2018 年期间在昆士兰儿童医院和布里斯班 Mater 医院接受颅颈减压手术的 CM-I 患者。收集了 66 名 0-18 岁患者的数据。通过在随访时计算芝加哥 Chiari 结局评分（CCOS）来评估术后结局。FVRA 是从先前描述的中矢状 T1 加权 MRI 中获取的（Seaman 等人在 J Neurosurg Pediatr 25:1-8, 2021）。该角度是在上、下髓帆之间形成的。
虽然 Seaman 等人的研究结果表明 FVRA > 65°与症状性 CM-I 之间存在很强的相关性，但这在我们的数据集上并不适用（p = 0.61）。此外，术前 FVRA 不能作为 CCOS 评估的术后结局预测工具（p = 0.50），术后 FVRA 的降低与结局改善无关（p = 0.81）。我们确实注意到术前存在脑干功能障碍的患者的结局明显更差（p = 0.03）。
小儿 CM-I 是一组具有挑战性的患者，通常由于年龄较小和缺乏语言技能而难以管理。影像学发现具有重要作用。虽然 FVRA 先前被报道可作为成人和儿科患者临床严重程度的决定因素，但我们发现该测量在我们的回顾性队列中价值不大。
