Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I
Syrinx resolution after posterior fossa decompression in patients with scoliosis secondary to Chiari malformation type I
复制标题
I 型 Chiari 畸形继发脊柱侧凸患者颅后窝减压后的空洞消退
DOI：
10.1007/s00586-011-2064-3
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发表时间：
2012-06-01
影响因子：
2.8
通讯作者：
Qiu, Yong
中科院分区：
文献类型：
--
作者：
Wu, Tao;Zhu, Zezhang;Qiu, Yong
继发于Chiari畸形I型(CMI)和脊髓空洞症(SM)的脊柱侧凸患者在后颅窝减压术(PFD)后脊髓空洞消失的描述在文献中很少报道。本研究旨在调查CMI继发脊柱侧弯患者的PFD预后，并确定PFD后改善预后的潜在预测因素。研究对象为2000年至2009年间接受PFD治疗的CMI和SM患者。纳入标准为(1)年龄为千分之几的货币记号，(2)诊断为SM合并CMI，(3)以脊柱侧弯为首发主诉，(4)接受过术前和随访的磁共振成像(MRI)。有获得性CMI异常或接受过蛛网膜下腔分流术的患者被排除在外。通过测量最大S/C比值和空洞长度来评价空洞消退情况。最后一次随访时S/C比值或长度下降20%被定义为显着的X线改善，完全分辨率被用来描述空洞在FDD后的消失。44名患者被纳入研究对象。术后6+/-A3个月44例，2年+/-A3个月37例，4年+/-A3个月26例，6年+/-A3个月15例。97.7%(43/44)的患者MRI表现明显改善。扁桃体下移距离(Mm)与手术效果显著相关(r=0.116，P=0.013)。术后6个月内观察到明显改善，之后持续缓慢改善。大多数继发于CMI的脊柱侧弯患者在PFD后注射器有显著改善。一般在6个月内消失，并以缓慢的速度持续数年。此外，扁桃体下沉的严重程度是标准PFD术后改善的潜在预测指标。
Description of syrinx resolution after posterior fossa decompression (PFD) in patients with scoliosis secondary to Chiari malformation type I (CMI) and syringomyelia (SM) has been rarely reported in the literature. This study was performed to investigate the outcome of PFD in patients with scoliosis secondary to CMI and to identify potential predictive factors for better outcome after PFD.Patients with scoliosis secondary to CMI and SM, who had undergone PFD during the period 2000 through 2009, were recruited. Inclusion criteria were (1) age a parts per thousand currency sign 18 years, (2) diagnosis of SM associated with CMI, (3) scoliosis as the first complaint, (4) having undergone preoperative and follow-up magnetic resonance imaging (MRI). Patients with acquired CMI anomalies or who had received syringosubarachnoid shunting were excluded. The maximal S/C ratio and syrinx length were measured to evaluate syrinx resolution after PFD. A 20% decrease in S/C ratio or length at the latest follow-up was defined as a significant radiographic improvement and complete resolution was used to describe the syrinx disappearing after PFD.44 patients were recruited. Follow-up MRI was conducted for all 44 patients at 6 +/- A 3 months postoperatively, for 37 patients at 2 years +/- A 3 months, for 26 patients at 4 years +/- A 3 months, and for 15 patients at 6 years +/- A 3 months. 97.7% (43 of 44) of patients showed significant radiographic improvement by MRI. The distance of tonsillar descent (mm) was correlated significantly with the surgical outcome (r = 0.116, P = 0.013). Significant improvement was observed within 6 months postoperatively, with continued slow improvement after that.Syringes showed significant improvement after PFD in most patients with scoliosis secondary to CMI. Resolution generally occurred within 6 months follow-up and continued at a slow rate for several years. In addition, the severity of tonsillar descent is a potential predictor for better improvement after standard PFD.