| ObjectivesChiari malformation,also known as subcerebellar tonsillar hernia malformation,is one of the most commonest nervous system malformation,and majority of Chiari malfromation belong to the type I.However,there is no unified standard for its treatment at present,no satisfactory results were obtained from uncorrect mangement for Chiari malformation.The objective of this study was to investigate the clinical characteristics of Chiari malformation type I with syringomyelia in adults and the related factors affecting the surgical prognosis.Patients and MethodsA total of 198 adult Chiari malformation type I(CM Ⅰ)patients with complete clinical data with syringomyelia who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2021 were enrolled in this study.One-way ANOVA and multinomial Logistic regression were used to summarize and analyze the clinical characteristics of Chiari malformation type I patients with syringomyelia,as well as the influence of gender,age,course of disease,distance of subcerebellar tonsillar hernia,width of syringomyelia,scoliosis,choice of surgical method and intraoperative operation on prognosis.The Chicago chiari outcome scale(CCOS),the improvement of syringomyelia and the hydrodynamic parameters of cerebrospinal fluid were used as important indicators to evaluate the prognosis.ResultsThe mean course of disease(i.e.,from the first symptom to admission for surgical treatment)of 198 patients was 48.1±33.4 months,and the mean follow-up time was 28.9±12.1 months.Among them,28 patients received posterior fossa decompression(PFD)(group A),the average net flow of cerebrospinal fluid at the outlet of midbrain aqueduct was 0.003±0.003(ml/cardiac cycle)before surgery and 0.005±0.004 after surgery(ml/cardiac cycle),P<0.01;There was no improvement or aggravation of the syringomyelia in 2 patients after surgery,the mean reduction rate of the syringomyelia volume was 54.3%,and the effective improvement rate of the syringomyelia was 85.7%.The mean Chicago Chiari Outcome Scale(CCOS)score was 13.9±1.19,The cure rate was 82.1%.82 patients received posterior cranial fossa decompression+duraplasty(PFDD)(group B),the average net flow of cerebrospinal fluid at the outlet of midbrain aqueduct was 0.002±0.002(ml/cardiac cycle)before surgery and 0.008±0.007 after surgery(ml/cardiac cycle),P<0.05;1 patient had no improvement or aggravation of syringomyelia after surgery,the mean reduction rate of syringomyelia volume was 66.8%,the effective improvement rate of syringomyelia was 96.3%,the average CCOS score was 14.36±0.99,and the cure rate was 91.5%.70 patients received posterior fossa decompression with tonsils(PFDRT)(group C),the average net flow of cerebrospinal fluid at the outlet of midbrain aqueduct was 0.001±0.001(ml/cardiac cycle)before surgery and 0.007±0.005 after surgery(ml/cardiac cycle),P<0.05;1 patient had no improvement or aggravation of the syringomyelia,the average reduction rate of the syringomyelia volume was 69.4%,the effective improvement rate of the syringomyelia was 97.1%,the average CCOS score was 14.51±1.67,and the cure rate was 91.4%.18 patients received PFD+ posterior atlanto-occipital fusion internal fixation(group D),the average net flow of cerebrospinal fluid at the outlet of midbrain aqueduct was 0.002±0.002(ml/cardiac cycle)before operation and 0.005±0.001(ml/cardiac cycle)after operation,P<0.05;The average reduction rate of syringomyelia volume was 61.2%,the effective improvement rate of syringomyelia was 77.8%,the average CCOS score was 13.56±1.23,and the cure rate was 88.9%%.Patients who received PFDD/PFDRT had a higher prognostic score than those who received PFD(14.42±2.78 versus 13.9±1.19,P<0.05),higher effective syringomyelia improvement rate(96.7%vs85.7%),and higher mean net flow of cerebrospinal fluid after operation(0.008±0.007vs0.005±0.004,P<0.01);Multivariate Logistic regression analysis showed that the course of disease≥36 months(OR=4.192;P<0.05)was a risk factor for poor prognosis in adult CM Ⅰ patients with syringomyelia.Conclusions1.For adult CM Ⅰ patients with syringomyelia,present results demonstrated that PFDD/PFDRT can bring more benefits to patients compared with PFD,and can improve the rate of improvement of clinical symptoms and the rate of syringomyelia reduction.2.When other abnormalities such as craniocervical articulation instability are evaluated preoperatively,posterior decompression combined with internal fixation should be performed in stage I on the basis of posterior fossa decompression.3.Long course of disease is a risk factor for poor prognosis of CM Ⅰ patients with syringomyelia.For adult CM Ⅰ patients with syringomyelia,surgical treatment should be performed as soon as possible to avoid missing the best surgical opportunity. |
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