小脑扁桃体下疝、脊髓空洞与后颅窝减压

在神经外科权威杂志“Neurosurgery”发表的文章

Neurosurgery. 2008 Jun;62:1307-13; discussion 1313. Links
Outcome of Chiari-associated syringomyelia after hindbrain decompression in children: analysis of 49 consecutive cases.Attenello FJ, McGirt MJ, Gathinji M, Datoo G, Atiba A, Weingart J, Carson B, Jallo GI.
Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
OBJECTIVE: Chiari I malformation is complicated by syringomyelia in many cases. Hindbrain decompression remains first-line surgical treatment（后路窝减压术依然是一线治疗）; however, the incidence, time course, and predictors of syrinx resolution remain unclear. We set out to determine predictors of syrinx improvement after hindbrain decompression for Chiari I- associated syringomyelia. METHODS: Forty-nine consecutive pediatric patients undergoing posterior fossa decompression for Chiari I-associated syringomyelia were followed with serial magnetic resonance imaging evaluations postoperatively. Clinical, radiological, and operative variables were assessed as predictors of syrinx improvement as a function of time using Kaplan-Meier plots and log-rank analysis. RESULTS: Mean patient age was 11 +/- 5 years（好像我们的患者成人更多一些）. Syringomyelia was symptomatic in 39 (80%) and asymptomatic in 10 (20%) cases. Twenty-one (54%) patients experienced symptom resolution (median, 4 mo postoperatively)（54%的患者症状改善，4例术后即有改善）. Twenty-seven (55%) patients experienced radiographic improvement in syringomyelia (median, 14 mo postoperatively)（55%的患者脊髓空洞的影像学改善，14例术后即有改善）. After hindbrain decompression, motor symptoms were associated with a 2.35 increased hazard ratio for symptom improvement (P = 0.031) versus all other symptoms（术后，运动症状改善最明显，与其他症状相比）. Among patients with sensory deficits, dysesthesia was associated with a 3.12 increased hazard ratio for symptom improvement (P = 0.032) versus symptoms of paresthesia or anesthesia. CONCLUSION: In our experience, just more than one-half of patients with Chiari- associated syringomyelia demonstrated clinical and radiographic improvement after hindbrain decompression（依据他们的经验，后路窝减压术后，一半多的患者的Chiari畸形相关的脊髓空洞临床症状和影像得到改善）. Median time to radiographic improvement lagged behind clinical improvement by 10 months（影像学改善要晚于临床症状减轻10个月，平均）. Motor symptoms were more likely to improve with hindbrain decompression. Paresthesia or anesthesia symptoms were less likely to improve with hindbrain decompression（运动障碍的症状改善最明显而感觉异常和麻木则术后改善不明显）. These findings may help guide surgical decision making and aid in patient education.