ABSTRACT

Objective

Syringomyelia is a common condition seen in patients with Chiari type-I malformation (CM1). The purpose of this retrospective study was to evaluate the long-term clinical and radiological outcomes of posterior fossa decompression with duraplasty (PFDD) with coagulation of tonsillar ectopia in consecutive surgically treated adult patients with CM1-related syringomyelia (CRS).

Methods

Over 9 years’ duration (1993–2001), medical charts of diagnosed patient with CM1 at our neurosurgical center were reviewed retrospectively. This study included adult patients with CM1 who had syringomyelia and underwent PFDD with coagulation of tonsillar ectopia surgery. The differences between the pre- and postoperative syrinx/cord ratio (S/C), the syrinx length, and the regression of herniated cerebellar tonsils on coronal and midsagittal MRIs were evaluated.

Results

A total of 87 surgical procedures (46 primary operations, 7 ventriculoperitoneal shunts, and 34 additional operations) for CRS were performed on 24 males and 22 females. The mean preoperative S/C was 0.59 ± 0.12. The means of regression in herniated cerebellar tonsils on mid-sagittal and coronal images were 11.8 ± 2.3 mm and 10.2 ± 2.2 mm (p < 0.0001), respectively. 35 (76.1%) patients were discharged after showing signs of recovery or improvement. Different complications occurred in 16 (34.8%) patients. Negative correlations were noticed between postoperative recovery/improvement and the long symptoms’ duration, the herniated tonsils’ extent, S/C, and the persistence of the herniated tonsils on the coronal images.

Conclusion

Early diagnosis of patients with CRS can improve surgical outcomes. Due to its efficacy in resolving clinical symptoms and syrinx cavities, PFDD is still an optimal surgical approach for CRS.

中文翻译：

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Chiari I 型畸形相关脊髓空洞症的长期手术结果：三级转诊医院的经验

摘要

客观的

脊髓空洞症是 Chiari I 型畸形 (CM1) 患者的常见病症。这项回顾性研究的目的是评估后颅窝减压联合硬脑膜成形术 (PFDD) 联合扁桃体异位凝固术在连续接受手术治疗的 CM1 相关脊髓空洞症 (CRS) 成人患者中的长期临床和放射学结果。

方法

在 9 年的时间里（1993-2001 年），对我们神经外科中心诊断出的 CM1 患者的病历进行了回顾性审查。这项研究包括患有脊髓空洞症并接受 PFDD 和扁桃体异位凝固手术的 CM1 成年患者。评估了冠状位和中矢状位 MRI 上的术前和术后空洞/脐带比 (S/C)、空洞长度以及小脑扁桃体突出的退化之间的差异。

结果

对 24 名男性和 22 名女性进行了总共 87 次 CRS 外科手术（46 次初级手术、7 次脑室腹腔分流术和 34 次额外手术）。平均术前 S/C 为 0.59 ± 0.12。在中矢状位和冠状位图像上，小脑扁桃体突出的回归平均值分别为 11.8 ± 2.3 mm 和 10.2 ± 2.2 mm (p < 0.0001)。35名（76.1%）患者在出现康复或好转迹象后出院。16 名（34.8%）患者出现不同的并发症。术后恢复/改善与长期症状持续时间、扁桃体突出范围、S/C和冠状图像上扁桃体突出的持续存在负相关。

结论

CRS患者的早期诊断可以改善手术结果。由于其在解决临床症状和空洞腔方面的功效，PFDD 仍然是 CRS 的最佳手术方法。