Pan Dong-Sheng, Yang Kai-Qi, Li Jin-Jiang, Wang Zhen, Zhang Jian-Fei, Zheng Nan, Yuan Xiao-Ying, Yu Sheng-Bo, Sui Hong-Jin
Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China.
Department of Anatomy, College of Basic Medical Sciences, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, 116044, China.
Sci Rep. 2025 Mar 19;15(1):9445. doi: 10.1038/s41598-025-92506-7.
Chiari malformation type I (CM-I) is the most common subtype of Chiari malformation which can lead to brainstem compression and alterations in cerebrospinal fluid (CSF) flow. Common complications in patients undergoing traditional surgical approach include pseudomeningocele, CSF leak, and exacerbation of symptoms. The authors present a new minimally invasive surgery technique for protection and strengthening of the myodural bridge (MDB) in order to prevent the postoperative complications. A retrospective study was performed on 55 CM-I patients undergoing surgical treatment from January 2019 to April 2024 in a center. These patients underwent the surgical procedure of either posterior fossa decompression with duraplasty and tonsillar coagulation (PFDDC) or PFDDC with protection and strengthening of the MDB (PFDDC + MDB). The clinical outcomes and complications of the two procedures. 29 patients underwent PFDDC, and 26 patients underwent PFDDC + MDB. Overall complications rates were significantly reduced in the PFDDC + MDB group (3.8% vs. 34.5%, P = 0.012). Meningitis was observed in 3 (10.3%) in the PFDDC group and 1 (3.8%) in the PFDDC + MDB group (P = 0.613). Pseudomeningocele was more frequent in the PFDDC group than in the PFDDC + MDB group (24.1% vs. 0%, P = 0.011). No patient required a revision operation. There were no statistical differences in symptom improvement between the two groups. PFDDC + MDB seems to be a safe and effective treatment for CM-I patients with or without syringomyelia. This new procedure can bring clinical improvement and lower complication rates.
Ⅰ型Chiari畸形（CM-Ⅰ）是Chiari畸形最常见的亚型，可导致脑干受压和脑脊液（CSF）流动改变。接受传统手术治疗的患者常见并发症包括假性脑脊膜膨出、脑脊液漏和症状加重。作者提出了一种新的微创手术技术，用于保护和加强肌硬膜桥（MDB），以预防术后并发症。对某中心2019年1月至2024年4月接受手术治疗的55例CM-Ⅰ患者进行了一项回顾性研究。这些患者接受了后颅窝减压联合硬脑膜成形术和扁桃体凝固术（PFDDC）或PFDDC联合MDB保护和加强术（PFDDC + MDB）。比较了两种手术的临床结果和并发症。29例患者接受了PFDDC，26例患者接受了PFDDC + MDB。PFDDC + MDB组的总体并发症发生率显著降低（3.8%对34.5%，P = 0.012）。PFDDC组有3例（10.3%）发生脑膜炎，PFDDC + MDB组有1例（3.8%）发生脑膜炎（P = 0.613）。PFDDC组假性脑脊膜膨出的发生率高于PFDDC + MDB组（24.1%对0%，P = 0.011）。没有患者需要进行翻修手术。两组在症状改善方面无统计学差异。PFDDC + MDB似乎是治疗有或没有脊髓空洞症的CM-Ⅰ患者的一种安全有效的方法。这种新手术可以带来临床改善并降低并发症发生率。
