Guyotat J, Bret P, Jouanneau E, Ricci A C, Lapras C
Service de Neurochirurgie, B-Hôpital Neurologique et Neurochirurgical P. Wertheimer, Lyon, France.
Acta Neurochir (Wien). 1998;140(8):745-54. doi: 10.1007/s007010050175.
The purpose of the present study is to evaluate retrospectively the effects of several intra-operative manipulations on the results of foramen magnum decompression (FMD) in patients having syringomyelia associated with type I Chiari malformation. Seventy-five patients having syringomyelia associated with Chiari I malformation were operated on between 1975 and 1996. This population was grouped into 4 subgroups according to the surgical protocol: group I = 42 patients with FMD alone; group II = 16 patients with FMD and third ventricle shunting; group III = 9 patients with FMD and syringosubarachnoid shunting (SSS); group IV = 8 patients with FMD and cerebellar tonsils resection. Pre- and postsurgical magnetic resonance imaging (MRI) studies were analyzed (and compared). Nine patients were lost to follow-up. The results were evaluated in the 66 remaining patients (mean follow-up: 52 months), using the Bidzinski's outcome scale (ref). Two patients (3%) died postoperatively, 31 (47%) had very good results (after additional surgery in 7), 16 (24.2%) had good results (after additional surgery in 7) and 17 (25.7%) had poor results despite further surgery in 9. A total of 27 reoperations were undertaken after primary FMD in 23 patients (35%). Thirty-nine patients (59%) had both pre- and postsurgical MRI evaluation. In 28 (72%) the syrinx had markedly decreased whereas it had remained stable in 11 (28%). Clinical results were not significantly different between the patients of groups I, II and III. Very good or good results were obtained in 24 patients (64.8%) of group I (after additional surgery in 10), in 8 (61.5%) of group II (after additional surgery in 1) and in 7 (87.5%) of group III (after additional surgery in 3). Results in group IV were as follows: 7 patients (87%) had very good results and one had a good result. With a mean follow-up of 28 months, no patient required additional surgery. Postsurgical MRI syrinx reduction was observed in all 8 patients either in the early postoperative course or on delayed followup. It is suggested that tonsils resection might enhance the results of FMD in individuals having Chiari I-related syringomyelia.
本研究的目的是回顾性评估几种术中操作对患有I型Chiari畸形相关脊髓空洞症患者枕骨大孔减压术（FMD）结果的影响。1975年至1996年间，对75例患有Chiari I畸形相关脊髓空洞症的患者进行了手术。根据手术方案，该人群被分为4个亚组：第一组 = 42例仅接受FMD的患者；第二组 = 16例接受FMD和第三脑室分流术的患者；第三组 = 9例接受FMD和脊髓蛛网膜下腔分流术（SSS）的患者；第四组 = 8例接受FMD和小脑扁桃体切除术的患者。对术前和术后的磁共振成像（MRI）研究进行了分析（并比较）。9例患者失访。使用Bidzinski结局量表（参考文献）对其余66例患者（平均随访时间：52个月）的结果进行了评估。2例患者（3%）术后死亡，31例（47%）效果非常好（7例接受了额外手术），16例（24.2%）效果良好（7例接受了额外手术），17例（25.7%）效果不佳，尽管9例患者接受了进一步手术。23例患者（35%）在初次FMD后共进行了27次再次手术。39例患者（59%）进行了术前和术后MRI评估。其中28例（72%）脊髓空洞明显缩小，11例（28%）保持稳定。第一组、第二组和第三组患者的临床结果无显著差异。第一组24例患者（64.8%）（10例接受了额外手术）、第二组8例患者（61.5%）（1例接受了额外手术）和第三组7例患者（87.5%）（3例接受了额外手术）获得了非常好或良好的结果。第四组的结果如下：7例患者（87%）效果非常好，1例效果良好。平均随访28个月，无患者需要额外手术。所有8例患者在术后早期或延迟随访中均观察到术后MRI脊髓空洞缩小。提示扁桃体切除术可能会提高患有Chiari I相关脊髓空洞症患者的FMD效果。
