Syrinx resolution is correlated with the upward shifting of cerebellar tonsil following posterior fossa decompression in pediatric patients with Chiari malformation type I
Syrinx resolution is correlated with the upward shifting of cerebellar tonsil following posterior fossa decompression in pediatric patients with Chiari malformation type I
复制标题
I 型 Chiari 畸形儿科患者后颅窝减压后，注射管分辨率与小脑扁桃体上移相关
DOI：
10.1007/s00586-014-3680-5
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发表时间：
2015-01-01
影响因子：
2.8
通讯作者：
Zhu, Zezhang
中科院分区：
文献类型：
--
作者：
Xie, Dingding;Qiu, Yong;Zhu, Zezhang
目的Chiari畸形I型（CMI）是一种以后脑畸形为特征的畸形。本研究旨在定量评估后脑后颅窝减压术（PFD）的位置的改变，并确定与空洞的决议在小儿患者CMI.MethodsEighty-seven例，年龄从5岁到18岁，谁接受PFD CMI 2006年9月至2012年9月之间的因素进行了回顾性分析。在正中矢状位MR图像上，术前和随访时定量评估延髓和小脑的位置。测量最大脊髓空洞/脊髓（S/C）比值和脊髓空洞长度。空洞的显着改善被定义为一个超过20%的最大S/C比或长度的下降在后续的MRI. Results 51的87例患者术前发现神经功能缺损，其中37（72.4%）获得改善，他们的症状在最后一次访问。总体而言，在末次随访时，66例（75.9%）患者观察到小脑扁桃体尖端向上移位。小脑扁桃体尖端纵向距离由16.47 ± 5.00 mm变化为13.89 ± 4.38 mm（P< 0.001）。79例（90.8%）病例中观察到明显的空洞消退。术前85例（97.7%）患者出现尖状小脑扁桃体，术后78例（91.8%）患者出现圆形小脑扁桃体。最大S/C比值的改善与小脑扁桃体尖端上移显著相关（P= 0.023）。结论PFD治疗CMI后，大多数患儿小脑扁桃体的位置和形态可恢复正常，小脑扁桃体尖端上移与空洞改善显著相关。根据这项研究，PFD不分流可能是有效的空洞继发于CMI的儿科人群。
PurposeChiari malformation type I (CMI) is characterized by deformed hindbrain. This study aimed to quantitatively evaluate the alterations in position of hindbrain after Posterior fossa decompression (PFD), and to identify the factors associated with syrinx resolution in pediatric patients with CMI.MethodsEighty-seven patients, aged from 5 to 18 years, who underwent PFD for CMI between September 2006 and September 2012 were retrospectively reviewed. On mid-sagittal MR images, the position of medulla oblongata and cerebellum was quantitatively evaluated preoperatively and at follow-up. The maximal syrinx/cord (S/C) ratio and syrinx length were also measured. Significant improvement of syrinx was defined as a more than 20 % decrease in maximal S/C ratio or length on follow-up MRI.ResultsNeurological deficits were found in 51 of the 87 patients preoperatively and 37 (72.4 %) of them obtained improvement of their symptoms at the last visit. Overall, upward shifting of the tip of cerebellar tonsil was observed in 66 (75.9 %) patients at the last follow-up. Moreover, the mean longitudinal distance of the tip of cerebella tonsil changed from 16.47 ± 5.00 to 13.89 ± 4.38 mm (P< 0.001) at final follow-up. Significant syrinx resolution was noticed in 79 (90.8 %) cases. Pointed cerebellar tonsils were found in 85 (97.7 %) of our patients preoperatively and 78 (91.8 %) of them acquired round cerebellar tonsils after PFD. The improvement of maximal S/C ratio was significantly correlated with upward shifting of the tip of cerebellar tonsil (P= 0.023).ConclusionsFollowing PFD for CMI, position and morphology of the cerebellar tonsil could revert to normal in most of the pediatric patients, and the upward shifting of the tip of cerebellar tonsil is significantly correlated with syrinx improvement. From this study, PFD without shunting may be effective for syrinx secondary to CMI in pediatric population.