Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients
Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients
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DOI：
10.1016/s0303-8467(00)00073-1
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发表时间：
2000-06-01
影响因子：
1.9
通讯作者：
Plets, C
中科院分区：
文献类型：
--
作者：
Depreitere, B;Van Calenbergh, F;Plets, C
背景资料：后颅窝减压术是目前大多数神经外科医生首选的治疗后脑相关性脊髓空洞症的首选手术方法，于1989年在我们中心重新引入。我们回顾性分析了22例从那时起接受手术的患者。方法：所有病例均经颅脊髓交界区MRI检查确诊。手术包括枕下骨瓣切除，C1后弧切除，必要时C2或C3椎板切除，最后进行宽硬脑膜成形术。硬膜内操作（蛛网膜打开、扁桃体凝固或切除）不一致。术后短期和长期的临床结果和MRI结果进行了评估。结果：21例患者中有16例（76%）在早期随访期间出现改善。在后期随访期间，19名患者中有13名（68%）改善，而5名患者（26%）出现明显恶化。对所有症状和体征均无明确影响。术后MR图像显示20例患者中有16例（80%）的结果良好，包括空洞塌陷或空洞直径减小。结论：我们认为后颅窝减压术是一种安全的手术，有相当大的临床改善机会。虽然总空洞塌陷不像空洞分流术那样常见，但临床结果可能更好。此外，在本研究中，临床结果与术后空洞大小之间似乎没有明确的相关性。(C)2000 Elsevier Science B.V.保留所有权利。
Background: The technique of posterior fossa decompression, nowadays preferred by most neurosurgeons as the first surgical option in the treatment of hindbrain associated syringomyelia, was reintroduced in our center in 1989. We present a retrospective analysis of 22 patients with this pathology who underwent the procedure since then. Methods: In all patients diagnosis was made by MRI of the craniospinal junction. The operation consisted of a suboccipital craniectomy, removal of the posterior are of C1, laminectomy of C2 or C3 when necessary and a wide duraplasty at the end. The intradural manipulations (opening of the arachnoid membrane, coagulation or resection of the tonsils) were not uniform. Postoperatively short- and long-term clinical outcome and MRI findings were assessed. Results: Sixteen out of 21 patients (76%) experienced an improvement in the early follow-up period. In the late follow-up period 13 out of 19 patients (68%) were improved, whereas five patients (26%) experienced a marked deterioration. There was no unequivocal effect on all symptoms and signs. Postoperative MR images showed a favorable result in 16 out of 20 patients (80%), consisting of syrinx collapse or reduction of the syrinx diameter. Conclusions: We conclude that decompression of the posterior fossa is a safe procedure with a considerable chance of clinical improvement. Although total syrinx collapse is not as frequently seen as in syrinx shunting procedures, the clinical outcome may be better. Moreover, there seemed to he no unequivocal correlation between clinical outcome and postoperative syrinx size in the present study. (C) 2000 Elsevier Science B.V. All rights reserved.