A Combinatorial Approach with Cerebellar Tonsil Suspension to Treating Symptomatic Chiari Malformation Type I in Adults: A Retrospective Study
Autor: | Pengfei Yan, Hongyang Zhao, Wende Zhu, Lei Wang, Yang D. Teng |
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Rok vydání: | 2020 |
Předmět: |
Adult
Male Decompressive Craniectomy medicine.medical_specialty Adolescent Decompression Young Adult 03 medical and health sciences 0302 clinical medicine CHIARI MALFORMATION TYPE I Cerebellum Humans Medicine Cervical Atlas Prospective cohort study Retrospective Studies medicine.diagnostic_test business.industry Suture Techniques Laminectomy Magnetic resonance imaging Retrospective cohort study Middle Aged Plastic Surgery Procedures medicine.disease Syringomyelia Arnold-Chiari Malformation nervous system diseases Surgery Regimen medicine.anatomical_structure Occipital Bone 030220 oncology & carcinogenesis Cerebellar tonsil Female Dura Mater Neurology (clinical) business 030217 neurology & neurosurgery |
Zdroj: | World Neurosurgery. 143:e19-e35 |
ISSN: | 1878-8750 |
DOI: | 10.1016/j.wneu.2020.02.184 |
Popis: | Primary Chiari malformations (CMs) are congenital defects of the skull base and brain. Among the 4 CM types, type I (CM-I) occurs most frequently and may cause somatosensorimotor, autonomic and vision symptoms. Presently, posterior fossa decompression alone (PFD) or with duraplasty (PFDD) and cerebellar tonsil (CbT) shrinkage tactics are standard treatments, albeit inherent issues. There has been no report on devising CbT suspension (CTS) to manage CM-I.1) To design a CTS protocol that can be used with CbT coagulation (CTC) and PFDD; 2) to evaluate the regimen for feasibility, safety, and efficacy in a retrospective study; and 3) to obtain data for planning prospective studies to validate PFDD + CTC + CTS as a novel approach to treating adult CM-I.PFDD + CTC + CTS (n = 17), PFDD + CTC (n = 13), and PFDD (n = 12) were performed for 42 adult patients (age range, 18-55 years; female:male = 27:15) following a balanced study design. Neck Disability Index (NDI), Chicago Chiari Outcome Scale (CCOS), and /magnetic resonance imaging/computed tomography were used to determine postsurgery outcomes for approximately 20 months.Comparing to PFDD + CTC or PFDD, patients receiving PFDD + CTC +CTS operation exhibited significantly improved group average NDI (10.72 ± 3.95%; P = 0.007), CbT elevation distance (7.06 ± 2.42 mm; P0.001, Kruskal-Wallis test; 55.7 ± 25.4% higher than the presurgery level; P0.001, analysis of variance), and syringomyelia syrinx retraction (P = 0.009, analysis of variance).The PFDD + CTC + CTS regimen appeared to be safe and potentially more efficacious in patients with CM-I evaluated for the period, relative to PFDD + CTC or PFDD treatment. Future prospective studies were warranted. |
Databáze: | OpenAIRE |
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