Effect of posterior fossa decompression on craniovertebral junction stability in the treatment of Chiari type I malformation

doi:10.3877/cma.j.issn.2095-123X.2021.06.005

Abstract

Abstract:

Objective

To investigate the effect of posterior fossus decompression for Chiari malformation typeⅠ (CM-Ⅰ) on the stability of craniocervical junction, to analyze the best treatment method of CM-Ⅰ.

Methods

The CM-Ⅰ patients who received cranial fossus decompression + enlarged cisternplasty in in the Neurosurgery Department of the Second Affiliated Hospital of Nanchang University from January 2015 to January 2020 were retrospectively collected. According to the imaging diagnostic parameters of craniocervical junction instability, the patients were divided into the stability group and the instability group. The surgical efficacy was evaluated and the influencing factors of instability were analyzed according to the myelomyelia volume, modified Japanese Orthopedic Association and the Chicago Chiari outcome scale.

Results

Of the 89 subjects who were followed up for 3 to 55 months, 4 had no craniocervical junction instability before surgery and had atlanto-occipitocervical joint instability 3 to 4 years after surgery, 85 in the stability group. The clinical symptoms and function of patients in both groups were significantly improved.

Conclusion

Posterior fossa decompression is safe and effective, and has no significant effect on the stability of craniocervical junction. Therefore, it is the preferred treatment for CM-Ⅰ.

Key words: Chiari malformation typeⅠ, Posterior fossa decompression, Craniovertebral junction instability, Posterior fossa volume

Lei Shu, Shigang Lyu, Zuyu Cheng, Juexian Xiao, Kai Huang, Xiaoyan Su. Effect of posterior fossa decompression on craniovertebral junction stability in the treatment of Chiari type I malformation[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(06): 343-348.

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References 27

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基本情况		数据
性别[例（%）]
	男性	34（38.2）
	女性	55（61.8）
年龄（岁，Mean±SD）		45.88±10.37
病程[月，M（P₂₅，P₇₅）]		24（0.25，360）
随访[月，M（P₂₅，P₇₅）]		36（3，55）
术前mJOA评分（分，Mean±SD）		14.80±1.40
术后CCOS（分，Mean±SD）		13.43±1.49
头痛[例（%）]		33（37.08）
颈痛[例（%）]		21（23.60）
肩痛[例（%）]		10（11.24）
肢体痛[例（%）]		8（8.16）
肢体乏力[例（%）]		40（44.94）
肢体麻木[例（%）]		60（67.42）
感觉障碍[例（%）]		5（5.62）
肌肉萎缩[例（%）]		6（6.74）
头晕[例（%）]		21（23.60）
脊髓空洞[例（%）]		63（70.79）
术前脊髓空洞体积[mm³，M（P₂₅，P₇₅）]		1141.60（0，2729.18）
术前CMA（Mean±SD）		149.88°±4.99°
术前小脑扁桃体下疝长度（mm，Mean±SD）		9.19±3.52
术前PFV（mm³，Mean±SD）		175.59±10.20

基本情况		数据
性别[例（%）]
	男性	34（38.2）
	女性	55（61.8）
年龄（岁，Mean±SD）		45.88±10.37
病程[月，M（P₂₅，P₇₅）]		24（0.25，360）
随访[月，M（P₂₅，P₇₅）]		36（3，55）
术前mJOA评分（分，Mean±SD）		14.80±1.40
术后CCOS（分，Mean±SD）		13.43±1.49
头痛[例（%）]		33（37.08）
颈痛[例（%）]		21（23.60）
肩痛[例（%）]		10（11.24）
肢体痛[例（%）]		8（8.16）
肢体乏力[例（%）]		40（44.94）
肢体麻木[例（%）]		60（67.42）
感觉障碍[例（%）]		5（5.62）
肌肉萎缩[例（%）]		6（6.74）
头晕[例（%）]		21（23.60）
脊髓空洞[例（%）]		63（70.79）
术前脊髓空洞体积[mm³，M（P₂₅，P₇₅）]		1141.60（0，2729.18）
术前CMA（Mean±SD）		149.88°±4.99°
术前小脑扁桃体下疝长度（mm，Mean±SD）		9.19±3.52
术前PFV（mm³，Mean±SD）		175.59±10.20

指标	首次住院评估	随访首次评估	t/Z值	P值
mJOA评分（分，Mean±SD）	14.88±1.33	16.76±0.95	7.632	<0.001
CCOS评分（分，Mean±SD）	13.49±1.11	15.12±0.85	7.594	<0.001
脊髓空洞体积[mm³，M（P₂₅，P₇₅）]	1113.8（0，2729.18）	450.9（0，1558.71）	5.627	<0.001
小脑扁桃体下疝长度[mm，M（P₂₅，P₇₅）]	8（7，10）	7（5.4，9.2）	5.266	<0.001
CMA（Mean±SD）	150.07°±4.98°	154.50°±4.33°	7.584	<0.001

指标	首次住院评估	随访首次评估	t/Z值	P值
mJOA评分（分，Mean±SD）	14.88±1.33	16.76±0.95	7.632	<0.001
CCOS评分（分，Mean±SD）	13.49±1.11	15.12±0.85	7.594	<0.001
脊髓空洞体积[mm³，M（P₂₅，P₇₅）]	1113.8（0，2729.18）	450.9（0，1558.71）	5.627	<0.001
小脑扁桃体下疝长度[mm，M（P₂₅，P₇₅）]	8（7，10）	7（5.4，9.2）	5.266	<0.001
CMA（Mean±SD）	150.07°±4.98°	154.50°±4.33°	7.584	<0.001

患者编号	术前							随访
患者编号	CCOS	mJOA	疝体长度（mm）	空洞体积（mm³）	CMA	BDI（mm）	BAI（mm）	CCOS	mJOA	疝体长度（mm）	空洞体积（mm³）	CMA	BDI（mm）	BAI（mm）
1	13	12	10	813.7	148.6°	7.5	5.6	15	15	7.0	455.6	122.3°	7.1	14.6
2	9	15	6	1809.0	142.8°	8.6	7.7	15	17	4.1	756.3	127.1°	5.6	13.5
3	12	11	12.4	3195.0	142.6°	4.3	7.8	16	16	8.8	1463.0	124.0°	6.4	16.0
4	13	14	11.2	1692.0	149.3°	8.4	5.7	15	16	7.2	671.4	123.6°	5.5	13.2

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