Zhang Lei, Li Ben Li, Wei Shuo, Hu Hong Wei, Chen Hong Fu, Fan Yue Chao, Zhang Hui, Ji Pei Zhi
Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Neurobiology, Xuzhou Medical University, Xuzhou, China.
Front Neurol. 2025 Mar 3;16:1556026. doi: 10.3389/fneur.2025.1556026. eCollection 2025.
The optimal surgical approach for treating Chiari malformation type I (CM-I) with syringomyelia remains a topic of debate. Key areas of controversy include the extent of decompressive craniectomy, the necessity of subarachnoid exploration, and whether to excise the herniated tonsils. In this study, we present our perspectives on these contentious issues through a retrospective analysis of the clinical efficacy of posterior fossa decompression with resection of tonsils (PFDRT) compared to posterior fossa decompression (PFD).
We conducted a retrospective analysis of clinical data from 162 patients diagnosed with CM-I and syringomyelia who underwent surgical intervention at the Affiliated Hospital of Xuzhou Medical University between January 2017 and December 2022. Among these, 58 patients underwent PFD, while 104 received PFDRT. The efficacy of the treatments was evaluated using the Chicago Chiari Deformity Prognosis Scale (CCOS) at 6 months post-surgery, with scores ranging from 13 to 16 indicating a favorable prognosis. Furthermore, the improvement of syringomyelia was assessed through magnetic resonance imaging (MRI) at the six-month follow-up.
Six months post-surgery, according to the Chiari Clinical Outcome Scale (CCOS) score, the improved rates for the PFD and PFDRT groups were 56.9 and 78.8%, respectively. Additionally, the recovery rates for syringomyelia in these groups were 55.2 and 76%, respectively. Statistically significant differences were observed in both the rates of favorable prognosis and syringomyelic improvement between the two groups ( < 0.05). The incidence of complications, including fever, cerebrospinal fluid leakage, intracranial infection, and incision infection, did not differ significantly between the groups ( > 0.05).
Our findings indicate that PFDRT yields superior outcomes in syringomyelia improvement and favorable prognoses compared to PFD, while maintaining comparable postoperative complication rates.
治疗伴有脊髓空洞症的Ⅰ型Chiari畸形（CM -Ⅰ）的最佳手术方法仍是一个有争议的话题。争议的关键领域包括减压颅骨切除术的范围、蛛网膜下腔探查的必要性以及是否切除疝出的扁桃体。在本研究中，我们通过回顾性分析扁桃体切除后颅窝减压术（PFDRT）与后颅窝减压术（PFD）的临床疗效，来阐述我们对这些有争议问题的观点。
我们对2017年1月至2022年12月在徐州医科大学附属医院接受手术干预的162例诊断为CM -Ⅰ和脊髓空洞症的患者的临床资料进行了回顾性分析。其中，58例患者接受了PFD，104例接受了PFDRT。术后6个月使用芝加哥Chiari畸形预后量表（CCOS）评估治疗效果，评分范围为13至16表示预后良好。此外，在六个月的随访中通过磁共振成像（MRI）评估脊髓空洞症的改善情况。
术后六个月，根据Chiari临床结果量表（CCOS）评分，PFD组和PFDRT组的改善率分别为56.9%和78.8%。此外，这些组中脊髓空洞症的恢复率分别为55.2%和76%。两组之间在良好预后率和脊髓空洞症改善方面均观察到统计学上的显著差异（<0.05）。两组之间包括发热、脑脊液漏、颅内感染和切口感染在内的并发症发生率没有显著差异（>0.05）。
我们的研究结果表明，与PFD相比，PFDRT在改善脊髓空洞症和良好预后方面产生了更好的结果，同时保持了相当的术后并发症发生率。
