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Title: [Comparison of posterior fossa decompression with and without duraplasty for surgical management for adult Chiari malformation type Ⅰ].
Author: Li HY, Li YM, Chen H, Li Y, Shi XW.
Journal: Zhonghua Yi Xue Za Zhi; 2017 Jul 04; 97(25):1947-1950. PubMed ID: 28693072.
Abstract:
Objective: To evaluate and compare the efficacy between posterior fossa decompression without duraplasty (PFD) and posterior fossa decompression with duraplasty (PFDD) in the surgical management for adult Chiari Ⅰ malformation. Methods: Fifty-seven patients suffered from Chiari malformation type Ⅰ were treated in Department of Neurosurgery, Henan Provincial People's Hospital from August 2008 to October 2013. Twenty-three patients received posterior fossa decompression without duraplasty and the other 34 patients received posterior fossa decompression with duraplasty. The clinical results were retrospectively analyzed to compare the efficacy of two different surgical approaches. Results: There was no death or severe neurological dysfunction case in 57 patients of the two groups. Patients undergoing PFD had shorter length of hospital stay[(13.7±3.5) d vs (16.2±4.1) d, P<0.05]and surgical time[(98.7±22.1) min vs (132.3±39.6)min, P<0.05]. Cerebrospinal fluid-related complications and intracranial infection were more common in patients undergoing PFDD[(0/23, 0) vs (8/34, 23.5%), P<0.05]. Clinical improvement was comparable in two groups[(15/23, 65.2%) vs (26/34, 76.5%), P>0.05]at the one-year follow-up. The rate of syrinx regression in patients with Syringomyelia was higher in patients undergoing PFDD[(3/12, 25%) vs (17/22, 77.3%), P<0.05]. Conclusion: For adult patients with Chiari malformation type Ⅰ, PFD has the advantages of simple manipulation, short length of hospital stay and low incidence of cerebrospinal fluid-related complications and intracranial infection, compared with PFDD. It is comparable to PFDD in clinical improvement, but the effect of PFD is not as good as that of PFDD in the aspect of syrinx regression. 目的： 探讨不剪开硬膜的单纯后颅窝减压术(PFD)和后颅窝减压硬膜成形术(PFDD)两种术式治疗Ⅰ型Chiari畸形的效果。 方法： 回顾性分析河南省人民医院神经外科自2008年8月至2013年10月收治的57例成人Ⅰ型Chiari畸形，采用不剪开硬膜的单纯后颅窝减压术或后颅窝减压硬膜成形术两种手术方式治疗效果。57例患者中采取PFD者23例，采取PFDD者34例。 结果： 两组患者均无手术死亡及严重神经功能障碍并发症发生。两组患者的住院时间[PFD组(13.7±3.5)d，PFDD组(16.2±4.1)d]及手术时间[PFD组(98.7±22.1)min，PFDD组(132.3±39.6)min]比较差异有统计学意义(P<0.05)。PFD组23例患者术后无脑脊液相关并发症和颅内感染发生，而PFDD组患者中脑脊液相关并发症和颅内感染共8例(23.5%)，与PFD组比较差异有统计学意义(P<0.05)。术后1年随访，PFD组症状改善15例，改善率65.2%; PFDD组症状改善26例，改善率76.5%，两组比较差异无统计学意义(P>0.05)。两组合并脊髓空洞的患者，PFD组脊髓空洞缩小率为25%(3/12), PFDD组为77.3%(17/22)，差异有统计学意义(P<0.05)。 结论： 对于成人Ⅰ型Chiari畸形患者，与PFDD相比，PFD操作简便，住院时间短，疗效满意，术后脑脊液相关并发症及颅内感染的发生率低，但在脊髓空洞缩小方面效果不如PFDD。.

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