| Objective:The objective of this study was to investigate factors associated with syrinx size in adult patients undergoing varied surgical procedures for Chiari malformation(CM)with syringomyelia.Background:Syringomyelia is among the most common concomitant complications of CM.However,factors associated with long-term syringomyelia prognosis following posterior fossa decompression are not well established.Also,there are no universal criteria defining improvement in syrinx.Methods:We retrospectively analyzed the demographic and clinical data of CM patients who underwent varied decompression surgeries from 2013 to 2018.Surgical outcomes of all enrolled patients with a 1-yr follow-up were collected.Patients were divided into 3 groups according to the procedures performed:posterior fossa decompression(PFD),posterior fossa decompression with dural plasty(PFDD),and PFDD plus obex unblocking.Divergent prognosis of syringomyelia was defined as a 3-category ordinal variable.A multivariable ordinal regression model was employed to estimate the relationship between patient variables and increased odds for better resolution of syringomyelia.Results:Seventy-three patients were included in the study.Among all syringomyelia patients,the regression analysis demonstrated that patients with shorter clivus length(P=0.033),lower Pavlov ratio(P=0.014),and obex unblocking(vs PFDD,P=0.001;vs PFD,P=0.010)were more likely to gain a better resolution of syringomyelia.Different CM types were not associated with surgical outcomes of syrinx(P=0.802).Chicago Chiari Outcome Scale(CCOS)of three surgical procedures were not statistically varied according to our study(P=0.941).Conclusions:Patients with shorter clivus length and lower Pavlov ratio received better syringomyelia resolution.Also,unblocking the obex received better syringomyelia resolution compared to dural plasty and bony decompression alone with the avoidance of increased postoperative complications and worse clinical outcomes. |
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