| ObjectivesArnold-Chiari malformation(ACM/CM),also known as subcerebellar tonsillar hernia malformation,has no standard treatment until now,especially for teenagers and children who are rarely seen in clinical practice,considering that surgical treatment may cause adverse effects on the growth and development of patients after surgery,it is necessary to be more cautious in the selection of surgical and treatment programs.In this study,we analyzed the clinical features of children with Chiari malformation complicated with syphilitic cavity and the related factors that might affect the prognosis.Patients and MethodsThis study included 45 Chiari malformation type 1(CM-1)patients with syringomyelia in the first affiliated hospital of Zhengzhou University from January 2016 to June 2020,who have detailed clinical data and younger than 18.We analyzed the related risk factors that may influence the prognosis of patients with Chiari malformation,including changes in cerebrospinal fluid dynamics,improvement degree of inferior hernia,improvement of clinical symptoms,length of operation,intraoperative blood loss and total length of hospital stay,after different treatment regimens.ResultsThe mean total course of disease,that is,from the first appearance of symptoms to the disappearance of symptoms or before the last follow-up,was 40.0 months,the mean incubation period from diagnosis to treatment was 21.9 months,and the mean follow-up time was 12.4 months.25 patients who underwent Posterior fossa decompression surgery(Posterior fossa decompression,PFD)or Posterior fossa decompression+dura keratoplasty(Posterior fossa decompression with duraplasty,PFDD)(Group A)and followed up for 6 months to 36 months,an average follow-up time of 13.2 months,all patients with postoperative spinal cord void volume,displayed on the imaging were reduced,on average,86.12%,while 96.0%effective improvement rate;7 patients received PFD+posterior atlanto-occipital fusion and internal fixation(Group B).The follow-up time was 5 months to 21 months,with an average of 7.5 months.The image reexamination showed that the syringomyelia volume decreased to different degrees and showed a positive correlation with the prolongation of follow-up time.Among them,the syringomyelia volume decreased not significantly in 1 case and no significant change in 2 cases,with an average of 45.35%and an effective improvement rate of 71.4%.Six patients received syphilitic shunt and nerve adhesion release and severation(Group C).The follow-up time was 4 months to 20 months,with an average of 10.0 months.Imaging review showed that the syphilitic cavity volume of most patients decreased,with an average of 88.44%and an improvement rate of 83.3%.In addition,7 patients were selected to receive conservative treatment(Group D),followed up for 7 months to 32 months,with an average of 19.0 months.Imaging review showed that all patients had different degrees of increase in the volume of the synoptic cavity,with an average of 312.3%,and an improvement rate of 0.ConclusionsFor children with CM-1 complicated with synodyelia,the timing of surgical treatment,surgical treatment,intraoperative decompression,reconstruction of the stability of posterior cranial fossa and craniocervical junction,and detection of the formation of pseudo membrane at the bottom of the fourth ventricle are the key factors affecting the prognosis of the patients.Therefore,clinicians should conduct individualized evaluation according to the specific conditions of children with Chiari malformation and adopt different surgical methods for precise treatment,so as to achieve the optimal clinical efficacy. |
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