Taylor Charles, Hall Samuel, Mathad Nijaguna, Wahab Salima, Waters Ryan, Chakraborty Aabir
Department of Neurosurgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom.
Surg Neurol Int. 2025 Jul 4;16:271. doi: 10.25259/SNI_40_2025. eCollection 2025.
Chiari malformation type 1 (CM-1) with syringomyelia is a common craniocervical abnormality and in symptomatic patients, there is ongoing debate regarding the optimum surgical strategy for decompressing the foramen magnum. The placement of a fourth ventricular-subarachnoid stent is a novel approach intended to increase symptom response rates and decrease the need for revision surgery, particularly in complex cases. The aim of this study was to present a single-center experience on the safety and efficacy of this technique.
A retrospective review was conducted of all CM-1 patients who underwent Foramen Magnum Decompression (FMD) + fourth ventricular stent between January 01, 2012, and September 20, 2022, at a single UK neurosurgical center. Patients were identified using a keyword search of the hospital's electronic medical records. Primary outcomes included syrinx size and neurological symptoms. Secondary outcomes included operative duration, length of stay, and number of revision procedures. Syrinx size was measured on axial T2 magnetic resonance imaging sequences.
17 patients received a stent as part of their FMD. The use of a stent improved or resolved the radiological appearance of the syrinx in 16 (87.5%) patients with an average AP diameter reduction of 57% (-4.86 mm standard deviation: 3.32). Clinically, 8 (62%) patients reported complete or partial resolution of limb symptoms. Following stent-assisted FMD only, 2 patients (11.7%) required further decompressive surgery.
This case series evaluates the use of a fourth ventricular stent as part of FMD for CM-1. The study demonstrates the efficacy of a stent with satisfactory radiological and clinical outcomes. The results support the use of fourth ventricular stenting as a useful adjunct in patients with complex obstruction of fourth ventricle outflow.
伴有脊髓空洞症的 Chiari 畸形 1 型（CM-1）是一种常见的颅颈区异常疾病，对于有症状的患者，关于枕大孔减压的最佳手术策略一直存在争议。置入第四脑室 - 蛛网膜下腔支架是一种新方法，旨在提高症状缓解率并减少翻修手术的需求，尤其是在复杂病例中。本研究的目的是介绍单中心关于该技术安全性和有效性的经验。
对 2012 年 1 月 1 日至 2022 年 9 月 20 日期间在英国一家神经外科中心接受枕大孔减压术（FMD）+ 第四脑室支架置入术的所有 CM-1 患者进行回顾性研究。通过对医院电子病历进行关键词搜索来识别患者。主要结局指标包括脊髓空洞大小和神经症状。次要结局指标包括手术时长、住院时间和翻修手术次数。脊髓空洞大小在轴向 T2 磁共振成像序列上进行测量。
17 例患者在 FMD 手术中置入了支架。支架的使用使 16 例（87.5%）患者的脊髓空洞影像学表现得到改善或消失，平均前后径缩小 57%（-4.86 mm，标准差：3.32）。临床上，8 例（62%）患者报告肢体症状完全或部分缓解。仅在支架辅助 FMD 术后，2 例（11.7%）患者需要进一步减压手术。
本病例系列评估了第四脑室支架作为 CM-1 的 FMD 一部分的应用情况。该研究证明了支架的有效性，其影像学和临床结局令人满意。结果支持将第四脑室支架置入作为第四脑室流出道复杂梗阻患者的一种有用辅助手段。
